Basic Information
| Provider Information | |||||||||
| NPI: | 1609868058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STILL | ||||||||
| FirstName: | ODELL | ||||||||
| MiddleName: | P. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1297 | ||||||||
| Address2: | |||||||||
| City: | HAWKINSVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310367297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787830299 | ||||||||
| FaxNumber: | 4787833730 | ||||||||
| Practice Location | |||||||||
| Address1: | 136 W DYKES ST | ||||||||
| Address2: | |||||||||
| City: | COCHRAN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 31014 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4789340030 | ||||||||
| FaxNumber: | 4787833730 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2005 | ||||||||
| LastUpdateDate: | 04/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 37085 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000539624O | 05 | GA | MEDICAID |