Provider Demographics
NPI:1255650867
Name:CHAMPION, DARRYL DESHAWN (MDX)
Entity Type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:DESHAWN
Last Name:CHAMPION
Suffix:
Gender:M
Credentials:MDX
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 LEALAND LANE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-554-7401
Mailing Address - Fax:615-547-9323
Practice Address - Street 1:444 LEALAND LANE
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-554-7401
Practice Address - Fax:615-547-9323
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist