Provider Demographics
NPI:1346341997
Name:WIN, THAN (MD)
Entity Type:Individual
Prefix:
First Name:THAN
Middle Name:
Last Name:WIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6413 WATERS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-2711
Mailing Address - Country:US
Mailing Address - Phone:912-352-7960
Mailing Address - Fax:912-335-8907
Practice Address - Street 1:6413 WATERS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2711
Practice Address - Country:US
Practice Address - Phone:912-352-7960
Practice Address - Fax:912-335-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-09-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA046014207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G75005Medicare UPIN