Individual
SHARRELL TONYA ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
755 US HIGHWAY 21 S, RIDGEWAY, SC 29130-6844
(803) 337-2920
(803) 337-3010
Mailing address
PO BOX 3788, COLUMBIA, SC 29230-3788
(803) 733-5969
(803) 753-5591
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18080
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP2358
—
SC
Enumeration date
11/15/2012
Last updated
07/17/2015
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