Provider Demographics
NPI:1164491387
Name:BATTLES, ODIE L JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ODIE
Middle Name:L
Last Name:BATTLES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3947
Mailing Address - Country:US
Mailing Address - Phone:731-427-9601
Mailing Address - Fax:731-427-4334
Practice Address - Street 1:8 MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301
Practice Address - Country:US
Practice Address - Phone:731-427-9601
Practice Address - Fax:731-427-4334
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD24965174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3079029Medicaid
TN3079029Medicare ID - Type Unspecified
TN3079029Medicaid