| Carol M. Odegaard, Md, Pc | |
|
261 Brookwood Ave Jackson GA 30233-1460 | |
| (678) 752-0555 | |
| (678) 752-0556 |
| Full Name | Carol M. Odegaard, Md, Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 261 Brookwood Ave, Jackson, Georgia |
| Authorized Official Name and Position | Carol M. Odegaard (CEO/PHYSICIAN) |
| Authorized Official Contact | 6787520555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Carol M. Odegaard, Md, Pc 261 Brookwood Ave Jackson GA 30233-1460 Ph: (678) 752-0555 | Carol M. Odegaard, Md, Pc 261 Brookwood Ave Jackson GA 30233-1460 Ph: (678) 752-0555 |
| NPI Number | 1114294972 |
|---|---|
| Provider Enumeration Date | 11/22/2011 |
| Last Update Date | 08/15/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114294972 | NPI | - | NPPES |
| 003122938A | Other | GA | MEDICAID FACILITY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 040495 (Georgia) | Primary |
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