Provider Demographics
NPI:1417971136
Name:WOODALL, EMILY CLAIRE (PA-C)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:CLAIRE
Last Name:WOODALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 OAK LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2513
Mailing Address - Country:US
Mailing Address - Phone:434-847-6132
Mailing Address - Fax:434-845-4870
Practice Address - Street 1:1330 OAK LN
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2513
Practice Address - Country:US
Practice Address - Phone:434-847-6132
Practice Address - Fax:434-845-4870
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00101327Medicare PIN
NC2757195Medicare ID - Type Unspecified
NCP79541Medicare UPIN