Active NPI
Upson Family Medical Center ,LLC
- Family Medicine Physician
- Thomaston, GA
National Provider Identifier
1124528344
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- Legal business name
- UPSON FAMILY MEDICAL CENTER ,LLC
- Practice address
- 1512 Highway 19 N
Thomaston, GA 30286-2258 - Phone
- (706) 647-2641
- NPI assigned
- Feb 14, 2018
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Daniel Owens
- Title
- Ceo
- Phone
- (706) 647-8111
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | Primary |
Addresses
Primary practice location
1512 Highway 19 N
Thomaston, GA 30286-2258
Mailing address
801 W Gordon St
Thomaston, GA 30286-3426
Phone (706) 647-8111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180409001182 | GA | Part B Supplier - Clinic/Group Practice | 9032472824 |
Receives reassigned benefits from 13 practitioners Practice locations: Thomaston, GA |
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1058713 | Upson Family Medical Center, LLC | Compliance | Feb 18, 2027 |
National Provider Directory
National Provider DirectoryMember of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
1512 Highway 19 N
Thomaston, GA 30286
Phone (706) 647-2641
Practitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Barnesville, GA
- NPI 1154423754
Family Medicine, GA
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1518566400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1769990400000",
"number": "1124528344",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "801 W GORDON ST",
"city": "THOMASTON",
"state": "GA",
"postal_code": "302863426",
"telephone_number": "706-647-8111",
"fax_number": "706-647-4389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1512 HIGHWAY 19 N",
"city": "THOMASTON",
"state": "GA",
"postal_code": "302862258",
"telephone_number": "706-647-2641"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "UPSON FAMILY MEDICAL CENTER ,LLC",
"organizational_subpart": "NO",
"enumeration_date": "2018-02-14",
"last_updated": "2026-02-02",
"certification_date": "2026-02-02",
"status": "A",
"authorized_official_last_name": "OWENS",
"authorized_official_first_name": "DANIEL",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "706-647-8111"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Family Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Thomaston, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2026; 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.