Provider Demographics
NPI:1356466890
Name:WOMACK, TAMARA J (OPA)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:WOMACK
Suffix:
Gender:F
Credentials:OPA
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OPA
Mailing Address - Street 1:260 FORT SANDERS WEST BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3355
Mailing Address - Country:US
Mailing Address - Phone:865-769-4500
Mailing Address - Fax:865-450-1214
Practice Address - Street 1:260 FORT SANDERS WEST BLVD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3355
Practice Address - Country:US
Practice Address - Phone:865-769-4500
Practice Address - Fax:865-450-1214
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN656246ZX2200X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZX2200XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherOrthopedic Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1516585Medicaid
TN103I979331Medicare PIN
TN1516585Medicaid
TN3667290Medicare PIN
TN103I979329Medicare PIN