Provider Demographics
NPI:1063629061
Name:WOMACK, VANESSA C (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:C
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:960 WOODSTOCK PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-4867
Mailing Address - Country:US
Mailing Address - Phone:770-517-2145
Mailing Address - Fax:770-517-2147
Practice Address - Street 1:960 WOODSTOCK PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-4867
Practice Address - Country:US
Practice Address - Phone:770-517-2145
Practice Address - Fax:770-517-2147
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040591207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine