Provider Demographics
NPI:1386616738
Name:THOMASTON MEDICAL CLINIC, PC
Entity type:Organization
Organization Name:THOMASTON MEDICAL CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-647-2147
Mailing Address - Street 1:615 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-4141
Mailing Address - Country:US
Mailing Address - Phone:706-647-2147
Mailing Address - Fax:706-647-7229
Practice Address - Street 1:615 S CENTER ST
Practice Address - Street 2:
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286-4141
Practice Address - Country:US
Practice Address - Phone:706-647-2147
Practice Address - Fax:706-647-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040336207R00000X
GARN100176 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP3567Medicare ID - Type UnspecifiedGROUP NUMBER