Basic Information
| Provider Information | |||||||||
| NPI: | 1750379863 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WOMBLE | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9247 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319089247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7066602171 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 19TH STREET | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 319011528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7063227884 | ||||||||
| FaxNumber: | 7066602171 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 044866 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0100156 | 01 | UNITED HEALTHCARE | OTHER | 450491390W9M1 | 01 | EVERGREEN | OTHER | P00160093 | 01 | RAILROAD MEDICARE | OTHER | 1813747 | 01 | FIRST HEALTH | OTHER | 000818419L | 05 | GA | MEDICAID | 52738836003 | 01 | GA | BCBS | OTHER | 000818419G | 05 | GA | MEDICAID | 2554240 | 01 | CIGNA | OTHER | 60027776 | 01 | AL | BCBS | OTHER |