Healthcare Provider Details

I. General information

NPI: 1619510740
Provider Name (Legal Business Name): TAURUS RAFEAL WOMBLE NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 AUSTELL RD
AUSTELL GA
30106-1121
US

IV. Provider business mailing address

2957 PEBBLE LN
SNELLVILLE GA
30078-2754
US

V. Phone/Fax

Practice location:
  • Phone: 470-732-4000
  • Fax:
Mailing address:
  • Phone: 404-319-9664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP222710
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: