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General NPI Number Information
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NPI Number | 1033425962
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Entity Type | Organization
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Legal Business Name | ODELL STILL DO LLC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 28 W RAILROAD AVE
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City | ALAMO
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State | GA
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Zip | 30411-3513
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Country | US
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Telephone | 912-568-1407
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Fax | 912-568-1579
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Provider Business Mailing Address
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Address Line | PO BOX 407
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City | VIDALIA
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State | GA
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Zip | 30475-0407
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Country | US
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Telephone | 912-537-4986
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TONY M OSTEEN
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Credential |
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Telephone | 912-538-5314
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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