Provider Demographics
NPI:1558365429
Name:ODUM, ERICA PATRESE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:PATRESE
Last Name:ODUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1665 BONNIE LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-0548
Mailing Address - Country:US
Mailing Address - Phone:901-531-8555
Mailing Address - Fax:901-531-8560
Practice Address - Street 1:1665 BONNIE LN
Practice Address - Street 2:SUITE 101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0548
Practice Address - Country:US
Practice Address - Phone:901-531-8555
Practice Address - Fax:901-531-8560
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-02-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN00000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics