Healthcare Provider Details

I. General information

NPI: 1881193985
Provider Name (Legal Business Name): ASO ODUS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 SHOREHAM DR
ATLANTA GA
30349-5818
US

IV. Provider business mailing address

1189 SHOREHAM DR
ATLANTA GA
30349-5818
US

V. Phone/Fax

Practice location:
  • Phone: 678-662-5834
  • Fax:
Mailing address:
  • Phone: 678-662-5834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: