Healthcare Provider Details

I. General information

NPI: 1043940141
Provider Name (Legal Business Name): CHRISTINA ANNA NICOLE ODOM FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2022
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 JOHNSON FERRY RD STE 604
MARIETTA GA
30068-2947
US

IV. Provider business mailing address

1 EMBARCADERO CTR FL 19
SAN FRANCISCO CA
94111-3628
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-663-6331
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP275604
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: