Provider Demographics
NPI:1003918376
Name:WOMACK, JAMES (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WOMACK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:WOMACL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:204 N WESTOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2983
Mailing Address - Country:US
Mailing Address - Phone:229-888-6559
Mailing Address - Fax:229-436-4107
Practice Address - Street 1:327-3 SUNSET AVENUE SW
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:GA
Practice Address - Zip Code:39870
Practice Address - Country:US
Practice Address - Phone:229-734-5250
Practice Address - Fax:229-734-5606
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1172363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1000000240AMedicaid
GA7011046OtherAETNA
GA970001400OtherRR MCARE - BCPHC
GA970001400OtherRR MCARE - BCPHC
GAR64769Medicare UPIN