C. Wayne Dodgen, MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

C. WAYNE DODGEN, MD, PC

Practice address

107 Jackson Ave
Suite a
Thomaston, GA 30286-3433

Phone

(706) 647-8101

Fax

(706) 647-8543

NPI assigned

Jun 24, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Wayne Dodgen, M.D.NPI 1104846625

Title

Ceo

Phone

(706) 647-8101

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Charles Wayne Dodgen, M.D.

  • Family Medicine Physician
  • Thomaston, GA
  • NPI 1104846625
  Medicare reassignment NPD Authorized official
• Diana Lynn Kreismanis, MSN, APRN, FNP-C

  • Nurse Practitioner
  • Thomaston, GA
  • NPI 1346885381
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104022425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4867",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312084867",
            "telephone_number": "706-647-8101",
            "fax_number": "706-647-8543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 JACKSON AVE",
            "address_2": "SUITE A",
            "city": "THOMASTON",
            "state": "GA",
            "postal_code": "302863433",
            "telephone_number": "706-647-8101",
            "fax_number": "706-647-8543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "C. WAYNE DODGEN, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DODGEN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "WAYNE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-647-8101",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA #",
            "identifier": "11DO948247",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Clarice Ann Brodie, RN
• Rhonda Brooks, RNC, WHNP
• Benjamin S Brown, M.D.
• John W Brown Jr., D.M.D.
• Jonathan Frank Busbee, M.D.
• Caldwell Corp of Thomaston Inc (Cherokee Pharmacy)
• Jennifer Beard Campbell, PMHNP-C
• Lacey Nicole Campbell, FNP-C
• George L Capo, DO
• Careconnect Health, Inc (Pediatric Convenient Care)

• Family Medicine Physician in Thomaston, GA
• Providers in Thomaston, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.