Healthcare Provider Details

I. General information

NPI: 1336831932
Provider Name (Legal Business Name): HERMAN HOWARD ODENS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ADAMS AVE
MEMPHIS TN
38103-2816
US

IV. Provider business mailing address

1948 YOUNG AVE APT 3
MEMPHIS TN
38104-5656
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-5437
  • Fax:
Mailing address:
  • Phone: 302-559-4531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247330
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: