MRS. GEORGIA ANN WOMBLE (NPI# 1649596867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649596867 |
| Entity Type | Individual |
| Full Name | MRS. GEORGIA ANN WOMBLE |
| Credential | PA-C |
| Practice Address |
18780 Interstate 20 Canton TX 75103-3593 |
| Mailing Address |
Po Box 846098 Dallas TX 75284-6098 |
| Practice Telephone | 9035674841 |
| Mailing Telephone | 9033246400 |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2017-03-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA06694 | TX | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | TRICARE | 75-2616977-001 | 01 |
| TX | 351539702 | 05 | |
| TX | RAIL ROAD MEDICARE | P01787495 | 01 |
| TX | BCBS | 8334NZ | 01 |
| Street Address |
18780 INTERSTATE 20 |
| City | CANTON |
| State | TX |
| Zip Code | 75103-3593 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396745758 | Michael Wayne Deeds | Physician Assistant | 18780 Interstate 20, Canton, TX 75103-3593 | 2005-07-28 |
| 1245657824 | Angela Burrus | Nurse Practitioner | 18780 Interstate 20, Canton, TX 75103-3593 | 2014-03-21 |
| 1407294101 | Emily Ann Dosier | Family Medicine | 18780 Interstate 20, Canton, TX 75103-3593 | 2013-06-05 |
| 1467693200 | Sheryl Ann Busch | Internal Medicine | 18780 Interstate 20, Canton, TX 75103-3593 | 2009-03-06 |
| 1134313083 | Christus Trinity Clinic | Clinic/Center | 18780 Interstate 20, Canton, TX 75103-3593 | 2007-09-04 |
| 1316048994 | Bradford James White | Nurse Practitioner | 18780 Interstate 20, Canton, TX 75103-3593 | 2006-09-26 |
| 1942218359 | Jerry Wharton Rodgers | Family Medicine | 18780 Interstate 20, Canton, TX 75103-3593 | 2006-08-03 |
| 1417991340 | Kevin Nixon | Emergency Medicine | 18780 Interstate 20, Canton, TX 75103 | 2006-06-14 |
| 1841231446 | Virginia Yolanda Gonzalez | Internal Medicine | 18780 Interstate 20, Canton, TX 75103-3593 | 2006-06-08 |
| 1720052566 | Kenneth Wayne Nixon | Family Medicine | 18780 Interstate 20, Canton, TX 75103-3593 | 2006-02-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265095202 | Brandi Jo Foster | Nurse Practitioner | 4437 Etheride Circle, Canton, TX 75103 | 2019-04-16 |
| 1124595087 | Melissa Williams | Nurse Practitioner | 1108 So. Buffalo St, Canton, TX 75103 | 2018-10-30 |
| 1295218667 | Jennifer Elaine Moore | Registered Nurse | 185 Vz Cr 2103, Canton, TX 75103 | 2018-09-12 |
| 1568945921 | Kelsey Lauren Nixon | Registered Nurse | 5640 Vzcr 4106, Canton, TX 75103 | 2018-09-12 |
| 1649770496 | Chelsea Boshart | Registered Nurse | 150 Vz Cr 4130, Canton, TX 75103 | 2018-02-19 |
| 1396292918 | Deanne Wheeler | Hearing Instrument Specialist | 150 E. Dallas Street, Canton, TX 75103 | 2016-09-01 |
| 1356701221 | Betsy Jill Chappell | Nurse Practitioner | 406 Tx-243, Canton, TX 75103 | 2016-03-04 |
| 1326435199 | Forever Kids Pediatric Clinic | Clinic/Center | 182 Privatet Road 6413, Canton, TX 75103 | 2015-04-20 |
| 1417255233 | Dallas County Hospital District | Skilled Nursing Facility | 1901 S Trade Days Blvd, Canton, TX 75103 | 2011-03-02 |
| 1922243906 | Brookshire Grocery Company | Pharmacy | 880 E State Highway 243, Canton, TX 75103 | 2008-12-05 |
| Find all providers in zip 75103 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326525270 | Kylie Broughal | Physician Assistant | 6119 St Hwy Rt 11, St Lawrence Medical Office Complex, Canton, NY 13617 | 2018-07-24 |
| 1740684083 | Nemi Thakker | Physician Assistant | 1351 Centennial Ct, Canton, MI 48187-5805 | 2014-10-15 |
| 1093047474 | Kirby Brown Reinecke | Physician Assistant | 120 Oakside Ct, Suite H, Canton, GA 30114-2471 | 2010-02-09 |
| 1578784013 | Aimee M Mitchell | Physician Assistant | 130 Oakside Court, Ste A Marietta Dermatology Associates Pa, Canton, GA 30114 | 2007-05-01 |
| 1447390315 | Morgan P Bowler | Physician Assistant | 460 Northside Cherokee Blvd Ste 450, Canton, GA 30115-8020 | 2007-02-08 |
| 1821052440 | James Willard Gilson | Physician Assistant | 6200 N Haggerty Rd, Canton, MI 48187 | 2006-04-12 |
| 1134188105 | Eddy Toussaint | Physician Assistant | 460 Northside Cherokee Blvd Ste 100, Canton, GA 30115-8017 | 2006-03-20 |
| 1255330098 | Stephen P Hinman | Physician Assistant | 205 State Street Road, Canton, NY 13617 | 2005-07-14 |
| 1467458612 | Barbara Jo Bizub | Physician Assistant | 4535 Dressler Rd Nw, Canton, OH 44718-2545 | 2005-06-22 |
| 1518521145 | Gabriel Martin Ibarra | Physician Assistant | 112 Southlake Cir, Canton, MS 39046-5368 | 2019-04-29 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.