Individual
MR. KENNETH LEE WOODSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATS, CRTS
Contact information
Practice address
945 BARNES RD, ANTIOCH, TN 37013-4418
(615) 533-1933
(615) 834-4782
Mailing address
945 BARNES RD, ANTIOCH, TN 37013-4418
(615) 533-1933
(615) 834-4782
Taxonomy
Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
Primary
113486
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E40
DMRS PROVIDER #
TN
01
—
00E52
DMRS PROVIDER #
TN
Enumeration date
01/29/2007
Last updated
07/08/2007
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