Odom, Kenneth Franklin

Odom, Kenneth Franklin is an individual health care provider with primary practice located at 1500 Ross Clark Cir , Dothan AL 36301-4754. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Odom, Kenneth Franklin can be contacted via phone (334) 793-2663.

Contact Information

Primary practice address
1500 Ross Clark Cir Dothan AL 36301-4754
Phone: (334) 793-2663
Fax: (334) 836-2247
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA.504 Alabama

Profile Details

NPI number 1982639738
LBN Legal business name Odom, Kenneth Franklin
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 11th, 2006
Last updated Oct 29th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982639738 NPPES
Georgia MEDICAID 003140733A
Georgia MEDICAID 121885
Georgia MEDICAID 003140729A
Georgia MEDICAID 009940319
Georgia Other 0515580730
Georgia Other 511-09068
Georgia Other 515-37977

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