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Individual
DR. SHELLY B ODOM JR.
Active
Individual
DR. SHELLY B ODOM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2015-01839
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0962807
CIGNA
NC
01
—
193FX
BCBS OF NC
ND
01
—
4187580
AETNA
NC
01
—
P01578817
RAILROAD MEDICARE
NC
Enumeration date
05/01/2012
Last updated
12/11/2016
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