Provider Demographics
NPI:1942367925
Name:ODELL, TERESA M (FNP-C)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:M
Last Name:ODELL
Suffix:
Gender:F
Credentials:FNP-C
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Mailing Address - Street 1:1065 JODECO RD
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-4953
Mailing Address - Country:US
Mailing Address - Phone:678-284-6300
Mailing Address - Fax:678-284-6282
Practice Address - Street 1:3000 SHAKERAG HL
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-3365
Practice Address - Country:US
Practice Address - Phone:770-631-9999
Practice Address - Fax:770-631-2415
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2011-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN081010 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAS49255Medicare UPIN
GA50BBJHLMedicare PIN