Healthcare Provider Details

I. General information

NPI: 1326970880
Provider Name (Legal Business Name): MILES ODLE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 GRAYSON CIR
UNION CITY TN
38261-5741
US

IV. Provider business mailing address

116 GRAYSON CIR
UNION CITY TN
38261-5741
US

V. Phone/Fax

Practice location:
  • Phone: 731-446-5751
  • Fax:
Mailing address:
  • Phone: 731-446-5751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: