Organization
WADE IN THE WATER MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARROLL G ODEM MD (PRESIDENT)
(423) 400-9910
Entity
Organization
Contact information
Practice address
5600 BRAINERD RD, FC5, CHATTANOOGA, TN 37411-5310
(423) 355-5471
(423) 355-5472
Mailing address
5600 BRAINERD RD, FC5, CHATTANOOGA, TN 37411-5310
(423) 355-5471
(423) 355-5472
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD24920
TN
Other
Enumeration date
06/11/2013
Last updated
04/30/2014
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