Courtney Chavis Odom, FNP-C
Individual provider Active NPI Family Nurse Practitioner · MC Coll, SC
NPI 1962095612 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1962095612
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 25309 (SC)
- Practice address
- 3080 Highway 15-401 E
MC Coll, SC 29570-6128 - Phone
- (843) 523-5751
- Fax
- (843) 523-6040
- NPI assigned
- Feb 13, 2021
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 13
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Caresouth Carolina Inc.
Practice addresses (Care Compare)
3080 Hwy 15-401 E
MC Coll, SC 29570-6128
Phone (843) 523-5751
545 Sumter Hwy
Bishopville, SC 29010-7601
Phone (803) 484-5317
999 Cheraw St
Bennettsville, SC 29512-2420
Phone (843) 479-2341
Hospital & facility affiliations
- Centerwell Home Health-Pee Dee
- Scotland Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220610001856 | SC | Practitioner - Nurse Practitioner | 8426447376 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 225769 | SC | MD | Registered Nurse |
| 5015042 | NC | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Caresouth Carolina, Inc. | Current |
Accepting new patients | |
| Caresouth Carolina, Inc. | Current | Accepting new patients | |
| Goshen Medical Center Incorporated | Current | Accepting new patients | |
| Caresouth Carolina, Inc | Past | Accepting new patients |
Locations
119 Crossover Rd
Beulaville, NC 28518
Phone (910) 298-3125
444 SW Center St
Faison, NC 28341
Phone (910) 267-0421
106 Jefferson St
Hamlet, NC 28345
Phone (910) 557-9447
270 N US Highway 701 Byp
Tabor City, NC 28463
Phone (706) 830-0277
545 Sumter Hwy
Bishopville, SC 29010
Phone (803) 484-5317
1268 S 4th St
Hartsville, SC 29550
Phone (843) 332-3422
3080 Highway 15-401 E
Mc Coll, SC 29570
Phone (843) 523-5751
Interoperability endpoints
- codom@goshenmedical.cloudcraftdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 225769 | SC | |
| Family Nurse Practitioner | 363LF0000X | 5015042 | NC | |
| Family Nurse Practitioner | 363LF0000X | 25309 | SC | Yes |
Addresses
Primary practice location
3080 Highway 15-401 E
MC Coll, SC 29570-6128
Mailing address
PO Box 1090
Hartsville, SC 29551-1090
Phone (843) 857-0111
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NP8401 | Medicaid | SC | |
| SCM901 | Other | SC | MEDICARE |
Other providers in MC Coll, SC
- Helping Hands Home Care LLC
- Tabitha Gail Hennagan
- Earline Little
- Sylvia McKoy Watts
- George Moore
- Tasha Smith
- Kaitlyn F Strawderman
- Kyah Turner
- Rebecca Fowler Vereen
All providers in MC Coll, SC · Family Nurse Practitioner in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.