Individual
JOHN W ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
594 S COLUMBIA AVE, STE 100, RINCON, GA 31326-0919
(912) 826-4057
(912) 826-2853
Mailing address
PO BOX 919, 594 S COLUMBIA DRIVE, STE 100, RINCON, GA 31326-0919
(912) 826-4057
(912) 826-2853
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
033661
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0437236D
—
GA
01
—
CN8505
RR MEDICARE
GA
Enumeration date
07/28/2005
Last updated
02/04/2010
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