Basic Information
| Provider Information | |||||||||
| NPI: | 1093241598 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ODOM | ||||||||
| FirstName: | REBECCA | ||||||||
| MiddleName: | ERION | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2333 KNOB CREEK RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239750764 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2333 KNOB CREEK RD | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234397201 | ||||||||
| FaxNumber: | 4234397219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2017 | ||||||||
| LastUpdateDate: | 06/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 65533 | TN | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.