Provider Demographics
NPI:1598490351
Name:WOMACK, ADAM DARRYLL
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:DARRYLL
Last Name:WOMACK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3216 BURTON CT
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1161
Mailing Address - Country:US
Mailing Address - Phone:301-418-3316
Mailing Address - Fax:
Practice Address - Street 1:4323 3RD ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3215
Practice Address - Country:US
Practice Address - Phone:240-676-3681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-17
Last Update Date:2022-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant