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Individual

MRS. GEORGIA ANN WOMBLE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

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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