Provider Demographics
NPI:1538541792
Name:WOMACK, ALICIA DAWN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:DAWN
Last Name:WOMACK
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:139 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GAFFNEY
Practice Address - State:SC
Practice Address - Zip Code:29340-4823
Practice Address - Country:US
Practice Address - Phone:864-487-7186
Practice Address - Fax:864-487-7246
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19572363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC62595096OtherMEDICARE PIN
SCSC62596121OtherMEDICARE PIN
SCSC6259J577OtherMEDICARE PIN
SCSC62596067OtherMEDICARE PIN
SCNP3288Medicaid