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C. WAYNE DODGEN, MD, PC
NPI 1104022425
Family Medicine in Thomaston, GA

Active since June 24, 2007CLIA 11D0948247 · Waiver
107 JACKSON AVE, SUITE A, THOMASTON, GA 30286(706) 647-8101(706) 647-8543 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About C. Wayne Dodgen, Md, Pc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

C. WAYNE DODGEN, MD, PC (NPI 1104022425) is a healthcare organization registered as a family medicine in Thomaston, Georgia and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through July 5, 2028 and lists Charles Wayne Dodgen, Ceo, as its authorized official.

NPPES Registry Identity

NPI1104022425
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameC. WAYNE DODGEN, MD, PC
Location Address107 JACKSON AVE, SUITE AThomaston, GA 30286-3433
Mailing AddressPo Box 4867Macon, GA 31208-4867 · (706) 647-8101 · Fax (706) 647-8543
Phone(706) 647-8101
Fax(706) 647-8543
Organization SubpartNo
Authorized OfficialCharles Wayne DodgenCeo · (706) 647-8101
Enumeration DateJune 24, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1104022425 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

107 JACKSON AVE, Thomaston, GA 30286
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Other Identifiers 1

Other11DO948247GA · Clia #

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D0948247

C Wayne Dodgen MD · Thomaston, GA
Active · expires Jul 5, 2028
CLIA Number11D0948247
Laboratory TypePhysician Office
Certificate Effective DateJuly 6, 2026
Certificate Expiration DateJuly 5, 2028
Laboratory DirectorWayne Dodgen
Laboratory Phone(706) 647-8101
Laboratory LocationC Wayne Dodgen MD107 Jackson Ave, Thomaston, GA 30286
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. CHARLES WAYNE DODGEN M.D.
Family Medicine
107 JACKSON AVE, SUITE A
THOMASTON, GA 30286
Upson County (706) 647-8101
DIANA LYNN KREISMANIS MSN, APRN, FNP-C
Nurse Practitioner
107 JACKSON AVE
THOMASTON, GA 30286
Upson County (678) 544-1107

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is C. Wayne Dodgen, MD, PC's NPI number?

The NPI number for C. Wayne Dodgen, MD, PC is 1104022425. It was assigned to this organization in the NPPES registry on June 24, 2007.

Where is C. Wayne Dodgen, MD, PC located?

C. Wayne Dodgen, MD, PC is located at 107 Jackson Ave Suite A, Thomaston, GA 30286. The listed phone number is (706) 647-8101.

What is C. Wayne Dodgen, MD, PC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does C. Wayne Dodgen, MD, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D0948247) is associated with this NPI, valid through July 5, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for C. Wayne Dodgen, MD, PC was last updated on August 22, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.