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General NPI Number Information
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NPI Number | 1821035908
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Entity Type | Individual
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Provider Name | ISAAC NATHAN O'DELL PA
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 701 MED TECH PKWY SUITE 300
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City | JOHNSON CITY
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State | TN
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Zip | 37604-2365
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Country | US
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Telephone | 423-232-8301
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Fax | 423-232-8304
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Provider Business Mailing Address
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Address Line | PO BOX 9150
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City | PADUCAH
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State | KY
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Zip | 42002-9150
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Country | US
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Telephone | 270-744-9600
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Fax | 270-744-0834
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA0000001330
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA0000001330
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License Number State | TN
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