Odom, John W
Odom, John W is an individual health care provider with primary practice located at 594 S Columbia Ave Ste 100, Rincon GA 31326-0919. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Odom, John W can be contacted via phone (912) 826-4057.Contact Information
Primary practice address
594 S Columbia Ave Ste 100
Rincon GA 31326-0919
Phone: (912) 826-4057
Fax: (912) 826-2853
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 033661 | Georgia |
Profile Details
| NPI number | 1508866773 |
|---|---|
| LBN Legal business name | Odom, John W |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 28th, 2005 |
| Last updated | Feb 4th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508866773 | NPPES |
| Georgia | MEDICAID | 0437236D | |
| Georgia | Other | CN8505 |
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