Provider Demographics
NPI:1013692391
Name:WOODALL, CHRISTOPHER DAVID I (CPSS)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:DAVID
Last Name:WOODALL
Suffix:I
Gender:M
Credentials:CPSS
Other - Prefix:MR
Other - First Name:CHRISTOPHER
Other - Middle Name:DAVID
Other - Last Name:WOODALL
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:CPSS
Mailing Address - Street 1:80 HIGHWAY 2227
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-1562
Mailing Address - Country:US
Mailing Address - Phone:606-485-4003
Mailing Address - Fax:606-425-4435
Practice Address - Street 1:80 HIGHWAY 2227
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-1562
Practice Address - Country:US
Practice Address - Phone:606-485-4003
Practice Address - Fax:606-425-4435
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1206827175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist