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General NPI Number Information
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NPI Number | 1740567643
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Entity Type | Individual
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Provider Name | ANGELA MARIE ODOM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 11/07/2011
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Last Update Date | 02/03/2020
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Provider Practice Location Address
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Address Line | 5621 HWY 21 S # NA
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City | RINCON
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State | GA
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Zip | 31326-9416
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Country | US
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Telephone | 912-441-1588
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Fax | 912-295-6033
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Provider Business Mailing Address
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Address Line | 5621 HWY 21 S
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City | RINCON
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State | GA
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Zip | 31326-9416
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Country | US
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Telephone | 912-295-5860
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Fax | 912-295-6033
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN149476
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License Number State | GA
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