Provider Demographics
NPI:1093018806
Name:PARESH K THANKI, MD, LLC
Entity Type:Organization
Organization Name:PARESH K THANKI, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARESH
Authorized Official - Middle Name:K
Authorized Official - Last Name:THANKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-490-0078
Mailing Address - Street 1:3718 VINEBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-7418
Mailing Address - Country:US
Mailing Address - Phone:912-490-0078
Mailing Address - Fax:912-490-0083
Practice Address - Street 1:1707 BOULEVARD SQ STE A
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8030
Practice Address - Country:US
Practice Address - Phone:912-490-0078
Practice Address - Fax:912-490-0083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GABT93065142084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I265217OtherMEDICARE PTAN
GA136071824EMedicaid