Individual
HETAL P THAKORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
811 13TH STREET, SUITE 10, AUGUSTA, GA 30901
(706) 434-1590
(803) 279-6001
Mailing address
811 13TH STREET, SUITE 10, AUGUSTA, GA 30901
(706) 434-1590
(803) 279-6001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
053556
GA
207R00000X
Internal Medicine Physician
Primary
053556
GA
208M00000X
Hospitalist Physician
053556
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
442892357D
—
GA
01
—
52058546-003
BCBS OF GA
GA
05
—
G53556
—
SC
Enumeration date
10/04/2006
Last updated
09/13/2013
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