Provider Information for 1992389639
The following NPI(s) contain information matching your search criteria. Please select the NPI to view all the data associated with the NPI.
Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know
BRIA ODOM
Sex: Female
NPI: 1992389639
Last Updated: 2024-12-17
Certification Date: 2024-12-17
Certification Date: 2024-12-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1992389639 | ||||||||
| Enumeration Date | 2021-05-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2370 RED MOON DR JACKSONVILLE, FL 32216-4708 United States Phone: 904-710-7986 | Fax: | ||||||||
| Primary Practice Address | 3027 SAN DIEGO RD JACKSONVILLE, FL 32207-3691 United States Phone: 904-493-7744 | Fax: | ||||||||
| Secondary Practice Address(es) | |||||||||
| Health Information Exchange |
| ||||||||
| Other Identifiers |
| ||||||||
| Taxonomy |
|