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General NPI Number Information
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NPI Number | 1588818603
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Entity Type | Organization
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Legal Business Name | JAMES C ODOM JR., MD., PC
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Dates
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Enumeration Date | 11/17/2008
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Last Update Date | 11/17/2008
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Provider Practice Location Address
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Address Line | 416 E MCPHERSON AVE
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City | NASHVILLE
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State | GA
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Zip | 31639-2276
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Country | US
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Telephone | 229-686-7671
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Fax | 229-686-3518
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Provider Business Mailing Address
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Address Line | PO BOX 1648
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City | TIFTON
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State | GA
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Zip | 31793-1648
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Country | US
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Telephone | 229-686-7671
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Fax | 229-686-3518
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JEFFREY K DANIEL
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Credential |
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Telephone | 229-387-0263
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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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