MEDICARE: TIFFANY FELICE ODUMS RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN280007	GA

General Provider Information

NPI Number	:	1598697153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIFFANY FELICE ODUMS RN

Provider Business Mailing Address
First Line	:	119 CLINTON LN
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-4702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 CLINTON LN
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31701-4702
Country	:	US
Telephone Number	:	229-733-0402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/29/2026
Last Update Date	:	05/29/2026

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