Healthcare Provider Details

I. General information

NPI: 1699778803
Provider Name (Legal Business Name): ARTHUR LYNN WOMBLE CRNA, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W MARKET ST
ATHENS AL
35611-2457
US

IV. Provider business mailing address

PO BOX 73709
NEWNAN GA
30271-3709
US

V. Phone/Fax

Practice location:
  • Phone: 256-233-9424
  • Fax:
Mailing address:
  • Phone: 770-251-2060
  • Fax: 678-854-9235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number070708-1568
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN196015
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-048920
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: