Provider Demographics
NPI:1720645633
Name:WOMACK, KARA LINDSEY
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:LINDSEY
Last Name:WOMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 CELESTIAL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30132-2102
Mailing Address - Country:US
Mailing Address - Phone:470-219-2749
Mailing Address - Fax:
Practice Address - Street 1:108 CELESTIAL RIDGE DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30132-2102
Practice Address - Country:US
Practice Address - Phone:470-219-2749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-27
Last Update Date:2019-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1770627515Medicaid