Provider Demographics
NPI:1437937364
Name:WOODALL, DAMON T
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:T
Last Name:WOODALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6512 HARSHMANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-3517
Mailing Address - Country:US
Mailing Address - Phone:937-789-4655
Mailing Address - Fax:
Practice Address - Street 1:6512 HARSHMANVILLE RD
Practice Address - Street 2:
Practice Address - City:HUBER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:45424-3517
Practice Address - Country:US
Practice Address - Phone:937-789-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-20
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRK778085343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)