Provider Demographics
NPI:1083842918
Name:UPSON FAMILY PHYSICIANS, LC
Entity Type:Organization
Organization Name:UPSON FAMILY PHYSICIANS, LC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEGGREY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-647-8111
Mailing Address - Street 1:PO BOX 1059
Mailing Address - Street 2:801 WEST GORDON STREET
Mailing Address - City:THOMASTON
Mailing Address - State:GA
Mailing Address - Zip Code:30286-0027
Mailing Address - Country:US
Mailing Address - Phone:706-647-7009
Mailing Address - Fax:
Practice Address - Street 1:612 WEST GORDON STREET
Practice Address - Street 2:SUITE C
Practice Address - City:THOMASTON
Practice Address - State:GA
Practice Address - Zip Code:30286
Practice Address - Country:US
Practice Address - Phone:706-647-7009
Practice Address - Fax:706-647-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty