MEDICARE: EMMA WOMACK

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	372600000X	Adult Companion		MS
2	376J00000X	Homemaker		MS

Other Identifiers

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

General Provider Information

NPI Number	:	1174037881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA WOMACK

Provider Business Mailing Address
First Line	:	389 PINEWOOD LN
Second Line	:
City	:	RIDGELAND
State	:	MS
Zip	:	39157-4150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 EXECUTIVE PL STE 2G
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39206-4134
Country	:	US
Telephone Number	:	769-235-6145
Fax Number	:

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

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/25/2017

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Directions to “ EMMA WOMACK ” Practice Location

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