Healthcare Provider Details

I. General information

NPI: 1659315737
Provider Name (Legal Business Name): CARMINE V ODDIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST STE 1B
MACON GA
31201-8638
US

IV. Provider business mailing address

1062 FORSYTH ST STE 1B
MACON GA
31201-8638
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-1208
  • Fax: 478-741-1557
Mailing address:
  • Phone: 478-741-1208
  • Fax: 478-741-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number51072
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number51072
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number51072
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: