Provider Demographics
NPI:1235836057
Name:WOODSON, LEE MELVIN JR (MS QP)
Entity Type:Individual
Prefix:MR
First Name:LEE
Middle Name:MELVIN
Last Name:WOODSON
Suffix:JR
Gender:M
Credentials:MS QP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 FISHERMAN DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9083
Mailing Address - Country:US
Mailing Address - Phone:336-362-0460
Mailing Address - Fax:
Practice Address - Street 1:5608 FISHERMAN DR
Practice Address - Street 2:
Practice Address - City:BROWNS SUMMIT
Practice Address - State:NC
Practice Address - Zip Code:27214-9083
Practice Address - Country:US
Practice Address - Phone:336-362-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28471865343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)