Provider Demographics
NPI:1740242676
Name:WOODALL, DIANE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:LYNN
Last Name:WOODALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6403 RIVER TIDE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2601
Mailing Address - Country:US
Mailing Address - Phone:901-685-8379
Mailing Address - Fax:901-374-0579
Practice Address - Street 1:7691 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3904
Practice Address - Country:US
Practice Address - Phone:901-516-6790
Practice Address - Fax:901-516-6753
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
TN193712080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine