Individual
MR. ISAAC NATHAN O'DELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
701 MED TECH PKWY, SUITE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA0000001330
TN
363AS0400X
Surgical Physician Assistant
Primary
PA0000001330
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1514552
—
TN
01
—
4126669
BCBS
TN
Enumeration date
05/31/2006
Last updated
12/10/2009
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