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General NPI Number Information
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NPI Number | 1205602976
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Entity Type | Individual
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Provider Name | DR. CHERYL ODOM
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Gender | Female
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Dates
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Enumeration Date | 12/04/2023
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 9849 ROME BLVD
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City | SUMMERVILLE
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State | GA
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Zip | 30747-1585
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Country | US
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Telephone | 706-857-4342
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 FORE WINDS HL
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City | OOLTEWAH
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State | TN
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Zip | 37363-9365
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Country | US
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Telephone | 404-242-7606
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 024411
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License Number State | GA
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