Healthcare Provider Details

I. General information

NPI: 1053874800
Provider Name (Legal Business Name): PARTH UDAYAN THAKKER MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5673 PEACHTREE DUNWOODY RD STE 350A
SANDY SPRINGS GA
30342-1731
US

IV. Provider business mailing address

220 N MERIDIAN ST APT 1510
INDIANAPOLIS IN
46204-2381
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4898
  • Fax: 678-843-6684
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01093147A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301518044
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number114338
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number010931478A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: