Provider Demographics
NPI:1508093816
Name:WOMACK, ROSALIND K (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:K
Last Name:WOMACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSALIND
Other - Middle Name:ELIZABETH
Other - Last Name:KEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBCHB
Mailing Address - Street 1:300 20TH AVE N STE 403
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-5180
Mailing Address - Country:US
Mailing Address - Phone:629-208-6200
Mailing Address - Fax:629-208-6201
Practice Address - Street 1:3754 MURFREESBORO PIKE
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:TN
Practice Address - Zip Code:37013-3878
Practice Address - Country:US
Practice Address - Phone:629-208-6200
Practice Address - Fax:629-208-6201
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA72171207Q00000X
TN47070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003155059BMedicaid
TNQ037437Medicaid