Provider Demographics
NPI:1518950260
Name:WOMACK, CHARLES T III (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:T
Last Name:WOMACK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2440
Mailing Address - Country:US
Mailing Address - Phone:931-528-5547
Mailing Address - Fax:931-526-2699
Practice Address - Street 1:320 N OAK AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2440
Practice Address - Country:US
Practice Address - Phone:931-528-5547
Practice Address - Fax:931-526-2699
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD9126208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2006424OtherBLUE CROSS BLUE SHEILD
TN2006424OtherTENNCARE SELECT
TN8720322OtherCIGNA HEALTHCARE
TN1940007OtherUNITED HEALTHCARE
TN3378641Medicaid
TN340012592OtherRAILROAD MEDICARE
TN1940007OtherUNITED HEALTHCARE
TN3157928Medicare ID - Type UnspecifiedMEDICARE INDIVIUAL NUMBER