Provider Demographics
NPI:1871336727
Name:WOODALL, DARNELL LLOYD JR (CHW)
Entity type:Individual
Prefix:MR
First Name:DARNELL
Middle Name:LLOYD
Last Name:WOODALL
Suffix:JR
Gender:M
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 2ND AVE APT 305
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48202-1446
Mailing Address - Country:US
Mailing Address - Phone:470-317-0855
Mailing Address - Fax:
Practice Address - Street 1:4700 SCHAEFER RD STE 255
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3655
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker