Individual
EMMA WOMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5430 EXECUTIVE PL STE 2G, JACKSON, MS 39206-4134
(769) 235-6145
Mailing address
389 PINEWOOD LN, RIDGELAND, MS 39157-4150
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
—
MS
376J00000X
Homemaker
Primary
—
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00487044
—
MS
05
—
09207260
—
MS
Enumeration date
11/17/2017
Last updated
11/25/2017
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