Individual
MRS. SHANNON WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1775 PARKER RD SE STE 200, CONYERS, GA 30094-6654
(470) 778-1148
Mailing address
PO BOX 1877, CONYERS, GA 30012-7242
(470) 778-1148
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN062876
GA
251E00000X
Home Health Agency
—
—
Other
Enumeration date
11/19/2012
Last updated
05/20/2021
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