Individual
KENNETH FRANKLIN ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1500 ROSS CLARK CIR, DOTHAN, AL 36301-4754
(334) 793-2663
(334) 836-2247
Mailing address
PO BOX 729, DOTHAN, AL 36302-0729
(334) 793-2663
(334) 836-2247
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.504
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003140729A
—
GA
05
—
003140733A
—
GA
05
—
009940319
—
AL
01
—
0515580730
MEDICARE
AL
05
—
121885
—
AL
01
—
511-09068
BCBS OF AL - HEALTHWEST
AL
01
—
515-37977
BCBS OF AL - RCC
AL
Enumeration date
07/11/2006
Last updated
10/29/2015
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