Provider Demographics
NPI: | 1336106368 |
---|---|
Name: | WOMACK, CATHERINE ROBILIO (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | CATHERINE |
Middle Name: | ROBILIO |
Last Name: | WOMACK |
Suffix: | |
Gender: | F |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 1000 |
Mailing Address - Street 2: | DEPT # 457 |
Mailing Address - City: | MEMPHIS |
Mailing Address - State: | TN |
Mailing Address - Zip Code: | 38148-0001 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 901-758-7888 |
Mailing Address - Fax: | 901-266-6445 |
Practice Address - Street 1: | 57 GERMANTOWN CT |
Practice Address - Street 2: | SUITE 100 |
Practice Address - City: | CORDOVA |
Practice Address - State: | TN |
Practice Address - Zip Code: | 38018-7273 |
Practice Address - Country: | US |
Practice Address - Phone: | 901-758-7888 |
Practice Address - Fax: | 901-266-6445 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-04-26 |
Last Update Date: | 2021-06-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 30211 | 207R00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TN | Q002428 | Medicaid | |
AR | 138874001 | Medicaid | |
TN | 4355721 | Other | BCBS |
TN | P01294153 | Other | RAILROAD MEDICARE |
MS | 00119457 | Medicaid | |
TN | Q002428 | Medicaid | |
TN | 4355721 | Other | BCBS |