Provider Demographics
NPI:1124406079
Name:HANSELL, MAGGIE CAMERON WOMACK (MD)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:CAMERON WOMACK
Last Name:HANSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:CAMERON
Other - Last Name:WOMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:MEDICAL CENTER BLVD.
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-716-1332
Mailing Address - Fax:
Practice Address - Street 1:1930 N PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-4817
Practice Address - Country:US
Practice Address - Phone:336-716-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-01849207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine