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General NPI Number Information
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NPI Number | 1154020451
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Entity Type | Individual
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Provider Name | MRS. IMANI A THOMAS-ODEN
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 259 ARROWHEAD BLVD
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City | JONESBORO
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State | GA
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Zip | 30236-1167
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Country | US
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Telephone | 770-685-5733
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Fax |
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Provider Business Mailing Address
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Address Line | 3557 MAIN ST
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City | COLLEGE PARK
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State | GA
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Zip | 30337-2624
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Country | US
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Telephone | 404-398-2622
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-85951
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB836741
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License Number State | GA
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