Organization
CAROL M. ODEGAARD, MD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROL M. ODEGAARD MD (CEO/PHYSICIAN)
(678) 752-0555
Entity
Organization
Contact information
Practice address
261 BROOKWOOD AVE, JACKSON, GA 30233-1460
(678) 752-0555
(678) 752-0556
Mailing address
261 BROOKWOOD AVE, JACKSON, GA 30233-1460
(678) 752-0555
(678) 752-0556
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
040495
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003122938A
MEDICAID FACILITY
GA
Enumeration date
11/22/2011
Last updated
08/15/2012
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