Provider Demographics
NPI:1194348391
Name:WOMACK, DEIRDRE DANNETTE
Entity type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:DANNETTE
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 1:221 BORDEAUX DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-5301
Mailing Address - Country:US
Mailing Address - Phone:404-539-8592
Mailing Address - Fax:
Practice Address - Street 1:221 BORDEAUX DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-5301
Practice Address - Country:US
Practice Address - Phone:404-539-8592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker