| C. Wayne Dodgen, Md, Pc | |
|
107 Jackson Ave Suite A Thomaston GA 30286-3433 | |
| (706) 647-8101 | |
| (706) 647-8543 |
| Full Name | C. Wayne Dodgen, Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 107 Jackson Ave, Thomaston, Georgia |
| Authorized Official Name and Position | Charles Wayne Dodgen (CEO) |
| Authorized Official Contact | 7066478101 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| C. Wayne Dodgen, Md, Pc Po Box 4867 Macon GA 31208-4867 Ph: (706) 647-8101 | C. Wayne Dodgen, Md, Pc 107 Jackson Ave Suite A Thomaston GA 30286-3433 Ph: (706) 647-8101 |
| NPI Number | 1104022425 |
|---|---|
| Provider Enumeration Date | 06/24/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1759417751 |
|---|---|
| Medicare Enrollment ID | O20100330000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104022425 | NPI | - | NPPES |
| 11DO948247 | Other | GA | CLIA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Georgia) | Primary |
| Provider Name | Charles W Dodgen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1104846625 PECOS PAC ID: 8022144021 Enrollment ID: I20100330000023 |
| Provider Name | Diana Lynn Kreismanis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346885381 PECOS PAC ID: 4587070206 Enrollment ID: I20210304000369 |
Upson Family Physicians, Lc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 612 West Gordon Street, Suite C, Thomaston, GA 30286 Phone: 706-647-7009 Fax: 706-647-7014 | |
Careconnect Health, Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 101 Deluxe Circle, Suite B, Thomaston, GA 30286 Phone: 706-647-7509 Fax: 706-647-6624 | |
Upson Family Medical Center ,llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1512 Highway 19 N, Thomaston, GA 30286 Phone: 706-647-2641 | |
Sabrina Lancaster Np-c Inc. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 502 W Main St, Thomaston, GA 30286 Phone: 706-938-4483 Fax: 706-938-0777 | |
Thomaston Internal Medicine,l.l.c. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 202 Cherokee Rd, Thomaston, GA 30286 Phone: 706-647-3200 Fax: 706-647-2346 | |
Upson County Hospital Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 206 Cherokee Rd, Thomaston, GA 30286 Phone: 706-647-8111 |