Provider Demographics
NPI:1558396598
Name:THAKOR, NITA (OD)
Entity Type:Individual
Prefix:
First Name:NITA
Middle Name:
Last Name:THAKOR
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2657 LENOX RD NE APT 210
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-3193
Mailing Address - Country:US
Mailing Address - Phone:678-596-7849
Mailing Address - Fax:
Practice Address - Street 1:2402 SOUTHLAKE MALL
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-2334
Practice Address - Country:US
Practice Address - Phone:770-961-1001
Practice Address - Fax:770-961-4073
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT02189152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist