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NPI Code Detail

MEDICARE: DR. MARTHA B WOMACK PHD

MEDICARE: DR. MARTHA B WOMACK PHD
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
1103TC0700XClinical Psychologist1624GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033185475
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARTHA B WOMACK PHD
Provider Business Mailing Address
First Line : 1536 N JEFFERSON ST
Second Line : JACKSONVILLE OUTPATIENT CLINIC
City : JACKSONVILLE
State : FL
Zip : 32209-6525
Country : US
Telephone Number : 912-447-5660
Fax Number :
Provider Business Practice Location Address
First Line : 1536 N JEFFERSON ST
Second Line : JACKSONVILLE OUTPATIENT CLINIC
City : JACKSONVILLE
State : FL
Zip : 32209-6525
Country : US
Telephone Number : 912-447-5660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2006
Last Update Date : 05/19/2014

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