1881736346 NPI number — MR. SHEPHERD A ODOM MD

Table of content: MR. SHEPHERD A ODOM MD (NPI 1881736346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881736346 NPI number — MR. SHEPHERD A ODOM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ODOM
Provider First Name:
SHEPHERD
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881736346
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4143 ATLANTA HIGHWAY
Provider Second Line Business Mailing Address:
FAMILY PRACTICE
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-271-4503
Provider Business Mailing Address Fax Number:
334-277-3215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4143 ATLANTA HIGHWAY
Provider Second Line Business Practice Location Address:
FAMILY PRACTICE
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-271-4503
Provider Business Practice Location Address Fax Number:
334-277-3215
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  00005590 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com