Provider Demographics
NPI:1528353372
Name:ANDERSON, ODETTE ADEAN (MD)
Entity type:Individual
Prefix:
First Name:ODETTE
Middle Name:ADEAN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:15 MEDICAL PARK STE 141
Mailing Address - Street 2:GENERAL PSYCHIATRY
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:803-434-1433
Mailing Address - Fax:803-434-4351
Practice Address - Street 1:15 MEDICAL PARK STE 141
Practice Address - Street 2:GENERAL PSYCHIATRY
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:803-434-1433
Practice Address - Fax:803-434-4351
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2018-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCLL335772084P0800X
LA3073502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry