Healthcare Provider Details

I. General information

NPI: 1245270727
Provider Name (Legal Business Name): BERNARD F ODDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 LUM CROWE RD
ROSWELL GA
30075-6879
US

IV. Provider business mailing address

328 LUM CROWE RD
ROSWELL GA
30075-6879
US

V. Phone/Fax

Practice location:
  • Phone: 912-293-1710
  • Fax:
Mailing address:
  • Phone: 912-293-1710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number48450
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number048450
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: