Provider Demographics
NPI:1033838628
Name:WOMICK, ANNA OLIVIA (CNM)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:OLIVIA
Last Name:WOMICK
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 WILMER ST NE UNIT 2513
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3020
Mailing Address - Country:US
Mailing Address - Phone:770-733-7115
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE STE 1275
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2240
Practice Address - Country:US
Practice Address - Phone:404-872-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN290072367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003273652Medicaid