Provider Demographics
NPI:1770050338
Name:WOMACK, CHRISTOPHER LEE
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:LEE
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 1:6417 TRAUTMAN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-4750
Mailing Address - Country:US
Mailing Address - Phone:501-606-1172
Mailing Address - Fax:
Practice Address - Street 1:3131 W CRAIG RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-0779
Practice Address - Country:US
Practice Address - Phone:702-623-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program