Healthcare Provider Details

I. General information

NPI: 1679787261
Provider Name (Legal Business Name): LAWRENCE NEIL ODOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 REYNOLDS ST STE 300
SAVANNAH GA
31405-6015
US

IV. Provider business mailing address

5353 REYNOLDS ST STE 300
SAVANNAH GA
31405-6015
US

V. Phone/Fax

Practice location:
  • Phone: 912-355-6005
  • Fax: 912-355-5643
Mailing address:
  • Phone: 912-355-6005
  • Fax: 912-355-5643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number44187
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number071127
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: