Healthcare Provider Details

I. General information

NPI: 1356937619
Provider Name (Legal Business Name): ERIKA ODOM PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/22/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6645 PEACHTREE DUNWOODY RD
ATLANTA GA
30328-1606
US

IV. Provider business mailing address

783 MEDLOCK RD
DECATUR GA
30033-5512
US

V. Phone/Fax

Practice location:
  • Phone: 678-632-4337
  • Fax:
Mailing address:
  • Phone: 404-234-3331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: