Provider Demographics
NPI:1417781022
Name:WOODALL, DARRELL
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
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 1:849 HARVARD ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1420
Mailing Address - Country:US
Mailing Address - Phone:330-760-6122
Mailing Address - Fax:
Practice Address - Street 1:849 HARVARD ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1420
Practice Address - Country:US
Practice Address - Phone:330-760-6943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty