Basic Information
| Provider Information | |||||||||
| NPI: | 1932102001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ODOM | ||||||||
| FirstName: | HARRELL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 222 22ND AVE N | ||||||||
| Address2: | STE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153295144 | ||||||||
| FaxNumber: | 6152842751 | ||||||||
| Practice Location | |||||||||
| Address1: | 222 22ND AVE N | ||||||||
| Address2: | STE 400 | ||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372031831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6153295144 | ||||||||
| FaxNumber: | 6152842751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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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 | 174400000X | 18412 | TN | N | Other Service Providers | Specialist | 207RI0011X | 18412 | TN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | 18412 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 3074482 | 05 | TN | MEDICAID |