Individual
MRS. COURTNEY CHAVIS ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3080 HIGHWAY 15-401 E, MC COLL, SC 29570-6128
(843) 523-5751
(843) 523-6040
Mailing address
PO BOX 1090, HARTSVILLE, SC 29551-1090
(843) 857-0111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
225769
SC
363LF0000X
Family Nurse Practitioner
Primary
25309
SC
363LF0000X
Family Nurse Practitioner
5015042
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP8401
—
SC
01
—
SCM901
MEDICARE
SC
Enumeration date
02/13/2021
Last updated
01/27/2025
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