Provider Demographics
NPI:1487693446
Name:WOMACK, JOHN THOMAS JR (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:WOMACK
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1455 RIVERSTONE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5627
Mailing Address - Country:US
Mailing Address - Phone:770-479-0500
Mailing Address - Fax:770-720-0104
Practice Address - Street 1:1455 RIVERSTONE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5627
Practice Address - Country:US
Practice Address - Phone:770-479-0500
Practice Address - Fax:770-720-0104
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002064152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28579OtherBCBS
28579AOtherBCBS
U93165Medicare UPIN
FL0651350001Medicare NSC
FL28579ZMedicare ID - Type Unspecified
FL0651350002Medicare NSC