Basic Information
Provider Information
NPI: 1134515943
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ODUM
FirstName: JAMES
MiddleName: DENNIS
NamePrefix:  
NameSuffix: JR.
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1600 7TH AVE S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352331711
CountryCode: US
TelephoneNumber: 2056389387
FaxNumber:  
Practice Location
Address1: 1600 7TH AVE S
Address2:  
City: BIRMINGHAM
State: AL
PostalCode: 352331711
CountryCode: US
TelephoneNumber: 2056389387
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/08/2015
LastUpdateDate: 05/23/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/23/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0203XMD.44208ALY Allopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
208000000XMD.44208ALN Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


Home