Healthcare Provider Details

I. General information

NPI: 1295282465
Provider Name (Legal Business Name): LOGAN WOMACK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2016
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 CHEATHAM ST
SPRINGFIELD TN
37172-2828
US

IV. Provider business mailing address

713 CHEATHAM ST
SPRINGFIELD TN
37172-2828
US

V. Phone/Fax

Practice location:
  • Phone: 615-463-6200
  • Fax: 615-463-6202
Mailing address:
  • Phone: 615-463-6200
  • Fax: 615-463-6202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number211939
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number41773
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: