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General NPI Number Information
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NPI Number | 1427256494
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Entity Type | Organization
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Legal Business Name | DR. MARK O'DANIEL & ASSOCIATES, P.A.
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 02/11/2008
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Provider Practice Location Address
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Address Line | 3031 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2422
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Country | US
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Telephone | 252-937-8222
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Fax | 252-937-6622
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Provider Business Mailing Address
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Address Line | 3031 ZEBULON RD
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-2422
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Country | US
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Telephone | 252-937-8222
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Fax | 252-937-6622
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Authorized Official
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Title or Position | OWNER
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Name | MARK BARNARD O'DANIEL
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Credential | D.O.
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Telephone | 252-937-8222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 9700116
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License Number State | NC
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