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General NPI Number Information
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NPI Number | 1093018806
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Entity Type | Organization
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Legal Business Name | PARESH K THANKI, MD, LLC
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Dates
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Enumeration Date | 12/16/2010
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Last Update Date | 12/16/2010
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Provider Practice Location Address
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Address Line | 1707 BOULEVARD SQ STE A
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City | WAYCROSS
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State | GA
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Zip | 31501-8030
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Country | US
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Telephone | 912-490-0078
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Fax | 912-490-0083
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Provider Business Mailing Address
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Address Line | 3718 VINEBROOKE DR
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City | VALDOSTA
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State | GA
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Zip | 31605-7418
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Country | US
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Telephone | 912-490-0078
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Fax | 912-490-0083
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PARESH K THANKI
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Credential | M.D.
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Telephone | 912-490-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | BT9306514
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License Number State | GA
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