Provider Demographics
NPI:1477062453
Name:WOODALL, JOHN (CADC II)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:WOODALL
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 CHICKAMAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-1407
Mailing Address - Country:US
Mailing Address - Phone:706-861-6458
Mailing Address - Fax:706-866-6277
Practice Address - Street 1:822 CHICKAMAUGA AVE
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-1407
Practice Address - Country:US
Practice Address - Phone:706-861-6458
Practice Address - Fax:706-866-6277
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)