Carol M. Odegaard, MD, PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

040495 Issued in GA

Legal business name

CAROL M. ODEGAARD, MD, PC

Practice address

261 Brookwood Ave
Jackson, GA 30233-1460

Phone

(678) 752-0555

Fax

(678) 752-0556

NPI assigned

Nov 22, 2011

Last updated

Aug 15, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Carol M. Odegaard, MDNPI 1700876554

Title

Ceo/Physician

Phone

(678) 752-0555

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carol M Odegaard, M.D.

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1700876554
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344988800000",
    "number": "1114294972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "261 BROOKWOOD AVE",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331460",
            "telephone_number": "678-752-0555",
            "fax_number": "678-752-0556"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 BROOKWOOD AVE",
            "city": "JACKSON",
            "state": "GA",
            "postal_code": "302331460",
            "telephone_number": "678-752-0555",
            "fax_number": "678-752-0556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROL M. ODEGAARD, MD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-22",
        "last_updated": "2012-08-15",
        "status": "A",
        "authorized_official_last_name": "ODEGAARD",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CEO/PHYSICIAN",
        "authorized_official_telephone_number": "678-752-0555",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "040495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID FACILITY",
            "identifier": "003122938A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Jackson, GA
• Providers in Jackson, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.