Provider Demographics
NPI:1790889095
Name:ODOM, LAWRENCE DUDLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:DUDLEY
Last Name:ODOM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5354 REYNOLDS ST
Mailing Address - Street 2:STE 333
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-354-8558
Mailing Address - Fax:912-354-5827
Practice Address - Street 1:5354 REYNOLDS ST
Practice Address - Street 2:STE 333
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-354-8558
Practice Address - Fax:912-354-5827
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA17016207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD00149553EMedicaid
GAD00149553EMedicaid