Healthcare Provider Details

I. General information

NPI: 1386616738
Provider Name (Legal Business Name): THOMASTON MEDICAL CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S CENTER ST
THOMASTON GA
30286-4141
US

IV. Provider business mailing address

615 S CENTER ST
THOMASTON GA
30286-4141
US

V. Phone/Fax

Practice location:
  • Phone: 706-647-2147
  • Fax: 706-647-7229
Mailing address:
  • Phone: 706-647-2147
  • Fax: 706-647-7229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN100176 NP
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number040336
License Number StateGA

VIII. Authorized Official

Name: CHRISTY WINKLES
Title or Position: PRACTICE MANAGER
Credential:
Phone: 706-647-2147