Provider Demographics
NPI:1962491134
Name:WOMACK, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:WOMACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:270 CHASTAIN RD NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-3012
Mailing Address - Country:US
Mailing Address - Phone:770-421-8005
Mailing Address - Fax:770-424-5662
Practice Address - Street 1:270 CHASTAIN RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-3012
Practice Address - Country:US
Practice Address - Phone:770-421-8005
Practice Address - Fax:770-424-5662
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA033759207X00000X, 207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20BDCRRMedicare PIN
GAF02966Medicare UPIN