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General NPI Number Information
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NPI Number | 1770875130
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Entity Type | Individual
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Provider Name | MORGAN WENNER THAKORE MD
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Gender | Female
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Dates
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Enumeration Date | 05/04/2011
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Last Update Date | 10/22/2019
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Provider Practice Location Address
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Address Line | 1111 GARREDD BLVD
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City | AUGUSTA
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State | GA
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Zip | 30909-6649
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Country | US
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Telephone | 706-296-6507
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 GARREDD BLVD STE A
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City | AUGUSTA
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State | GA
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Zip | 30909-6751
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Country | US
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Telephone | 706-296-6507
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | RTP 005639
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 074114
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License Number State | GA
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