1295289411 NPI number — MS. ANNA LANE WOMACK LPC, NCC

Table of content: MS. ANNA LANE WOMACK LPC, NCC (NPI 1295289411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295289411 NPI number — MS. ANNA LANE WOMACK LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOMACK
Provider First Name:
ANNA
Provider Middle Name:
LANE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295289411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 RIVER VISTA DR
Provider Second Line Business Mailing Address:
#634
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30339-7602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
404-316-6495
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2759 DELK RD SE
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30067-8847
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-401-4596
Provider Business Practice Location Address Fax Number:
678-401-3126
Provider Enumeration Date:
08/04/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC008735 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)