Healthcare Provider Details

I. General information

NPI: 1649393679
Provider Name (Legal Business Name): SCOTT GREGORY WOMACK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 09/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S PANTOPS DR
CHARLOTTESVILLE VA
22911-8672
US

IV. Provider business mailing address

110 SOUTH PANTOPS DR.
CHARLOTTESVILLE VA
22911
US

V. Phone/Fax

Practice location:
  • Phone: 434-977-5160
  • Fax: 434-977-5202
Mailing address:
  • Phone: 434-977-5160
  • Fax: 434-977-5202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101241345
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number0101241345
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: