Individual
MRS. GEORGIA ANN WOMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
18780 INTERSTATE 20, CANTON, TX 75103-3593
(903) 567-4841
Mailing address
PO BOX 846098, DALLAS, TX 75284-6098
(903) 324-6400
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA06694
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
351539702
—
TX
01
—
75-2616977-001
TRICARE
TX
01
—
8334NZ
BCBS
TX
01
—
P01787495
RAIL ROAD MEDICARE
TX
Enumeration date
04/13/2010
Last updated
03/17/2017
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