Active NPI
Jaime Woodall
- Dentist
- Collinsville, VA
National Provider Identifier
1679925614
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401415310
- Practice address
- 4721 Kings Mountain Rd
Collinsville, VA 24078-1274 - Phone
- (276) 647-3802
- NPI assigned
- Jul 1, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401415310 | VA | Primary |
Addresses
Primary practice location
4721 Kings Mountain Rd
Collinsville, VA 24078-1274
Mailing address
4721 Kings Mountain Rd
Collinsville, VA 24078-1274
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415310 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1467331200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551225600000",
"number": "1679925614",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4721 KINGS MOUNTAIN RD",
"city": "COLLINSVILLE",
"state": "VA",
"postal_code": "240781274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4721 KINGS MOUNTAIN RD",
"city": "COLLINSVILLE",
"state": "VA",
"postal_code": "240781274",
"telephone_number": "276-647-3802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODALL",
"first_name": "JAIME",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-01",
"last_updated": "2019-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401415310",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collinsville, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.