Healthcare Provider Details

I. General information

NPI: 1336106368
Provider Name (Legal Business Name): CATHERINE ROBILIO WOMACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 GERMANTOWN CT SUITE 100
CORDOVA TN
38018-7273
US

IV. Provider business mailing address

PO BOX 1000 DEPT # 457
MEMPHIS TN
38148-0001
US

V. Phone/Fax

Practice location:
  • Phone: 901-758-7888
  • Fax: 901-266-6445
Mailing address:
  • Phone: 901-758-7888
  • Fax: 901-266-6445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number30211
License Number StateTN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierQ002428
Identifier TypeMEDICAID
Identifier StateTN
Identifier Issuer
# 2
Identifier138874001
Identifier TypeMEDICAID
Identifier StateAR
Identifier Issuer
# 3
Identifier4355721
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerBCBS
# 4
IdentifierP01294153
Identifier TypeOTHER
Identifier StateTN
Identifier IssuerRAILROAD MEDICARE
# 5
Identifier00119457
Identifier TypeMEDICAID
Identifier StateMS
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: