| Upson Family Physicians, Lc | |
|
612 West Gordon Street Suite C Thomaston GA 30286 | |
| (706) 647-7009 | |
| (706) 647-7014 |
| Full Name | Upson Family Physicians, Lc |
|---|---|
| Speciality | Family Medicine |
| Location | 612 West Gordon Street, Thomaston, Georgia |
| Authorized Official Name and Position | Jeggrey Tarrant (CEO) |
| Authorized Official Contact | 7066478111 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Upson Family Physicians, Lc Po Box 1059 801 West Gordon Street Thomaston GA 30286-0027 Ph: (706) 647-7009 | Upson Family Physicians, Lc 612 West Gordon Street Suite C Thomaston GA 30286 Ph: (706) 647-7009 |
| NPI Number | 1083842918 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 08/12/2020 |
| Medicare PECOS PAC ID | 3072659242 |
|---|---|
| Medicare Enrollment ID | O20091002000004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083842918 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Laura B Moore |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1619926177 PECOS PAC ID: 9133106735 Enrollment ID: I20040701000885 |
| Provider Name | William S Taunton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548482995 PECOS PAC ID: 6305915554 Enrollment ID: I20100212000366 |
| Provider Name | Benjamin Paul Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508880352 PECOS PAC ID: 0840321535 Enrollment ID: I20100624000232 |
| Provider Name | Brandi J Swatts |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205277993 PECOS PAC ID: 7113169848 Enrollment ID: I20130809000065 |
| Provider Name | Patricia Hall |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1932404662 PECOS PAC ID: 1759537640 Enrollment ID: I20141017000068 |
| Provider Name | Lisa Hammock |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366968729 PECOS PAC ID: 2264791326 Enrollment ID: I20180117001909 |
| Provider Name | Christina Leigh H Noguera |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1952734436 PECOS PAC ID: 6204191562 Enrollment ID: I20180607002025 |
| Provider Name | Corey C Fussell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497103824 PECOS PAC ID: 5294063483 Enrollment ID: I20190826003942 |
| Provider Name | Meagan Fussell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134578669 PECOS PAC ID: 9638462062 Enrollment ID: I20191113003543 |
| Provider Name | Lisa G Ingram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104456235 PECOS PAC ID: 8820426455 Enrollment ID: I20200314000001 |
| Provider Name | Michael W Savelle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568078483 PECOS PAC ID: 0143631242 Enrollment ID: I20201120002005 |
| Provider Name | Jasmine Donesha Shackelford |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629606264 PECOS PAC ID: 8729401500 Enrollment ID: I20230808000060 |
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