Individual
DR. MARTHA B WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1536 N JEFFERSON ST, JACKSONVILLE OUTPATIENT CLINIC, JACKSONVILLE, FL 32209-6525
(912) 447-5660
Mailing address
1536 N JEFFERSON ST, JACKSONVILLE OUTPATIENT CLINIC, JACKSONVILLE, FL 32209-6525
(912) 447-5660
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1624
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000841574A
—
GA
Enumeration date
02/26/2006
Last updated
05/19/2014
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