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General NPI Number Information
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NPI Number | 1487693446
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Entity Type | Individual
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Provider Name | JOHN THOMAS WOMACK JR. OD
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 1455 RIVERSTONE PKWY STE 100
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City | CANTON
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State | GA
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Zip | 30114-5627
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Country | US
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Telephone | 770-479-0500
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Fax | 770-720-0104
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Provider Business Mailing Address
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Address Line | 1455 RIVERSTONE PKWY STE 100
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City | CANTON
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State | GA
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Zip | 30114-5627
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Country | US
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Telephone | 770-479-0500
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Fax | 770-720-0104
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002064
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License Number State | GA
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