Organization
C. WAYNE DODGEN, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES WAYNE DODGEN M.D. (CEO)
(706) 647-8101
Entity
Organization
Contact information
Practice address
107 JACKSON AVE, SUITE A, THOMASTON, GA 30286-3433
(706) 647-8101
(706) 647-8543
Mailing address
PO BOX 4867, MACON, GA 31208-4867
(706) 647-8101
(706) 647-8543
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11DO948247
CLIA #
GA
Enumeration date
06/24/2007
Last updated
08/22/2020
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