Individual
DR. CARROLL G ODEM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6380 BELLS FERRY RD STE 107, ACWORTH, GA 30102-5435
(404) 989-7384
(855) 604-0965
Mailing address
8309 GRINDER CREEK PL, CHATTANOOGA, TN 37421-2745
(423) 400-9910
(423) 332-5195
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD24920
TN
207R00000X
Internal Medicine Physician
51171
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3882406
—
TN
Enumeration date
06/09/2005
Last updated
03/12/2021
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