Individual
DR. BERNARD F ODDI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
328 LUM CROWE RD, ROSWELL, GA 30075-6879
(912) 293-1710
Mailing address
328 LUM CROWE RD, ROSWELL, GA 30075-6879
(912) 293-1710
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
48450
GA
207R00000X
Internal Medicine Physician
Primary
048450
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000864069E
—
GA
01
—
10058822
AMERIGROUP
GA
05
—
G48450
—
SC
Enumeration date
06/06/2006
Last updated
10/04/2013
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