MEDICARE: LILLIAN WOMBLE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1023615531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILLIAN WOMBLE

Provider Business Mailing Address
First Line	:	3232 UNION CHURCH ROAD
Second Line	:
City	:	WARTHEN
State	:	GA
Zip	:	31094
Country	:	US
Telephone Number	:	478-363-9381
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 UNION CHURCH ROAD
Second Line	:
City	:	WARTHEN
State	:	GA
Zip	:	31094
Country	:	US
Telephone Number	:	478-363-9381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	10/07/2020

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Directions to “ LILLIAN WOMBLE ” Practice Location

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