Provider Demographics
NPI:1124333521
Name:ODIGIE, JULIE I (MS)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:I
Last Name:ODIGIE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4809 AARON DR
Mailing Address - Street 2:
Mailing Address - City:CANE RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4221
Mailing Address - Country:US
Mailing Address - Phone:615-578-0466
Mailing Address - Fax:
Practice Address - Street 1:4809 AARON DR
Practice Address - Street 2:
Practice Address - City:CANE RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37013-4221
Practice Address - Country:US
Practice Address - Phone:615-578-0466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1000000007037172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker