Healthcare Provider Details

I. General information

NPI: 1184600629
Provider Name (Legal Business Name): BARNETT EDWARD O'DELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 E CHEVES ST SUITE 200
FLORENCE SC
29506-2716
US

IV. Provider business mailing address

901 E CHEVES ST SUITE 200
FLORENCE SC
29506-2716
US

V. Phone/Fax

Practice location:
  • Phone: 843-662-2299
  • Fax: 843-656-2001
Mailing address:
  • Phone: 843-662-2299
  • Fax: 843-656-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number11189
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: