Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 30619 | SC |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 30619 | SC |
NPI | 1366579666 |
---|---|
Provider Name | Dr. John Wesley Womack III |
First Address | Greenville, SC 29615-4816 |
Second Address | Greenville, SC 29615-4816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2007 |
Last Update Date | 16/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
306190 | (05) | SC |
8157 | MEDICARE PTAN (01) | SC |
AA2803 | (02) | SC |