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NPI Code Detail

MEDICARE: TAURUS RAFEAL WOMBLE NP-C

MEDICARE: TAURUS RAFEAL WOMBLE NP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAPRN-NP222710GA

General Provider Information

NPI Number : 1619510740
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAURUS RAFEAL WOMBLE NP-C
Provider Business Mailing Address
First Line : 2957 PEBBLE LN
Second Line :
City : SNELLVILLE
State : GA
Zip : 30078-2754
Country : US
Telephone Number : 404-319-9664
Fax Number :
Provider Business Practice Location Address
First Line : 3950 AUSTELL RD
Second Line :
City : AUSTELL
State : GA
Zip : 30106-1121
Country : US
Telephone Number : 470-732-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2019
Last Update Date : 12/08/2025

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