Individual
DR. CHARLES WAYNE DODGEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 JACKSON AVE, SUITE A, THOMASTON, GA 30286-3433
(706) 647-8101
(706) 647-8543
Mailing address
107 JACKSON AVE, SUITE A, THOMASTON, GA 30286-3433
(706) 647-8101
(706) 647-8543
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17100
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000116355B
—
GA
Enumeration date
07/20/2006
Last updated
03/30/2016
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