Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 14492 | NH |
NPI | 1003090986 |
---|---|
Provider Name | Jodie Ann Dionne-Odom |
First Address | Birmingham, AL 35294-2050 |
Second Address | Birmingham, AL 35294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2007 |
Last Update Date | 17/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1016706 | (05) | VT |
30208942 | (05) | NH |