Odom, Cecil Douglas

Odom, Cecil Douglas is an individual health care provider with primary practice located at 1020 River Oaks Drive, Ste 310, Jackson MS 39232. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gynecology, which is considered as his primary health care specialty. Odom, Cecil Douglas can be contacted via phone (601) 932-5006.

Contact Information

Primary practice address
1020 River Oaks Drive, Ste 310 Jackson MS 39232
Phone: (601) 932-5006
Fax: (601) 932-4548
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gynecology 207VG0400X 05821 Mississippi

Profile Details

NPI number 1093815474
LBN Legal business name Odom, Cecil Douglas
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 25th, 2006
Last updated Oct 18th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093815474 NPPES
Mississippi MEDICAID 00017818

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