Provider Demographics
NPI:1770875130
Name:THAKORE, MORGAN WENNER (MD)
Entity type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:WENNER
Last Name:THAKORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MORGAN
Other - Middle Name:RUTH
Other - Last Name:WENNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1111 GARREDD BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6751
Mailing Address - Country:US
Mailing Address - Phone:706-296-6507
Mailing Address - Fax:
Practice Address - Street 1:1111 GARREDD BLVD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6649
Practice Address - Country:US
Practice Address - Phone:706-296-6507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-04
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARTP 005639207N00000X
GA074114207N00000X
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program