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NPI Code Detail

MEDICARE: ERICA SHONTA WOMACK LMSW

MEDICARE: ERICA SHONTA WOMACK LMSW
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
11041C0700XClinical Social WorkerMSW010107GA

General Provider Information

NPI Number : 1861160715
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERICA SHONTA WOMACK LMSW
Provider Business Mailing Address
First Line : 76 TWELVE OAKS DR SE
Second Line :
City : CARTERSVILLE
State : GA
Zip : 30120-5801
Country : US
Telephone Number : 404-360-2060
Fax Number :
Provider Business Practice Location Address
First Line : 1640 POWERS FERRY RD SE BLDG 14-200
Second Line :
City : MARIETTA
State : GA
Zip : 30067-1459
Country : US
Telephone Number : 770-342-8072
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2021
Last Update Date : 09/03/2021

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