Basic Information
| Provider Information | |||||||||
| NPI: | 1962491134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOMACK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 270 CHASTAIN RD NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301443012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704218005 | ||||||||
| FaxNumber: | 7704245662 | ||||||||
| Practice Location | |||||||||
| Address1: | 270 CHASTAIN RD NW | ||||||||
| Address2: | |||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301443012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704218005 | ||||||||
| FaxNumber: | 7704245662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 03/31/2008 | ||||||||
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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 | 207X00000X | 033759 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0004X | 033759 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery |
No ID Information.