CHISOM CHIJIOKE ODOGWU (NPI# 1346801362) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1346801362 |
| Entity Type | Individual |
| Full Name | CHISOM CHIJIOKE ODOGWU |
| Practice Address |
20 Glenlake Pkwy Atlanta GA 30328-3473 |
| Mailing Address |
1679 Pinto Trl Jonesboro GA 30236-5189 |
| Practice Telephone | 8006111811 |
| Mailing Telephone | 6785776194 |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-08-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 9389 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2400 Mount Zion Pkwy, Jonesboro, GA 302362500 | 8006111811 |
| Street Address |
20 GLENLAKE PKWY |
| City | ATLANTA |
| State | GA |
| Zip Code | 30328-3473 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487655528 | Thomas Wilson Phillips | Radiology | 20 Glenlake Pkwy, Radiation Oncology, Atlanta, GA 30328 | 2005-08-10 |
| 1659998177 | Jamie Elizabeth Coates | Pharmacist | 20 Glenlake Pkwy, Atlanta, GA 30328-3431 | 2020-06-30 |
| 1891335014 | Jenna R Van Zelfden | Nurse Practitioner | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2020-01-15 |
| 1790269579 | Lauren Erin Holcomb | Physician Assistant | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2018-09-18 |
| 1528592094 | Kurtis Bertram | Podiatrist | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2017-04-12 |
| 1598111536 | Tiffany Casper | Advanced Practice Midwife | 20 Glenlake Pkwy, Atlanta, GA 30328 | 2016-05-09 |
| 1417343120 | Kaiser Foundation Health Plan of Georgia, Inc. | Pharmacy | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2015-04-09 |
| 1538419726 | James Joseph Weigel | Social Worker | 20 Glenlake Pkwy, Behavioral Health, Atlanta, GA 30328 | 2012-09-14 |
| 1053674903 | Yi-jou Tsai | Psychiatry & Neurology | 20 Glenlake Pkwy, Atlanta, GA 30328-3473 | 2012-06-15 |
| 1912264029 | Andrea Lynn Ledbetter | Physician Assistant | 20 Glenlake Pkwy, Kaiser Permanente Glenlake Dept of Gastroenterology, Atlanta, GA 30328 | 2012-04-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467910042 | Amber Andrews | Behavior Technician | 750 Hammond Drive Bldg 7 Suite 100, Atlanta, GA 30328 | 2019-03-04 |
| 1215492830 | Ryan William Dubinin | Behavior Technician | 750 Hammond Drive, Building 7, Suite 100, Atlanta, NJ 30328 | 2019-02-07 |
| 1346710142 | Emily Rose Lloyd Swavely | Speech-Language Pathologist | 5825 Glenridge Rd., Building 1, Suite 133, Atlanta, GA 30328 | 2018-12-05 |
| 1063994481 | Mark Edward Brachmanski | Optometrist | 800 Mount Vernon Highway Ne, Suite 130, Atlanta, GA 30328 | 2018-09-01 |
| 1407352578 | Nina Brown | Massage Therapist | 7100 Peachtree Dunwoody Rd Ste 110, Sandy Springs, GA 30328 | 2018-04-05 |
| 1336657741 | Renee Usher Reeves | Assistant Behavior Analyst | 750 Hammond Dr Building 7, Suite 100, Atlanta, GA 30328 | 2018-01-19 |
| 1487168274 | Patricia Nicole Felder | Student in an Organized Health Care Education/Training Program | 270 Carpenter Dr, Ne, Suite # 400, Atlanta, GA 30328 | 2017-12-01 |
| 1447762927 | Ponders Podiatry LLC | Podiatrist | 275 Carpenter Drive Ne, Suite 106, Atlanta, GA 30328 | 2017-10-24 |
| 1770093601 | Syed M Rasheed | Physician Assistant | 5788 Roswell Rd Ste 100, Atlanta, GA 30328 | 2017-10-05 |
| 1437678190 | Jeanette Denise Jones | Counselor | 270 Carpenter Drive, Suite 400, Sandy Springs, GA 30328 | 2017-09-13 |
| Find all providers in zip 30328 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659970408 | Laura N Gillespie | Physician Assistant | 1800 Howell Mill Rd., Suite 450, Atlanta, GA 30318 | 2020-10-22 |
| 1104433689 | Alexander Hartley Sprague | Physician Assistant | 244 13th St Ne Apt 208, Atlanta, GA 30309-3656 | 2020-09-28 |
| 1972117919 | Gregory Zimmerman | Physician Assistant | 2669 Fleur De Lis Pl, Atlanta, GA 30360-1409 | 2020-09-08 |
| 1083227821 | Jessica Haley Senft | Physician Assistant | 4274 Olde Mill Ln Ne, Atlanta, GA 30342-3400 | 2020-08-30 |
| 1801405758 | Philip Sangster | Physician Assistant | 3485 Greystone Cir, Atlanta, GA 30341-5854 | 2020-07-27 |
| 1114544525 | Nicole Warner | Physician Assistant | 1100 Faith Ave Se, Atlanta, GA 30316-1504 | 2020-07-01 |
| 1770108516 | Bita Ranjbari | Physician Assistant | 659 Auburn Ave Se, Suite 505, Atlanta, GA 30312 | 2020-06-08 |
| 1972125557 | Karen Charisse Forbes | Physician Assistant | 1600 Clifton Rd Ne # H16-1, Atlanta, GA 30329-4018 | 2020-05-17 |
| 1588290316 | Julie Teresa Lovelly | Physician Assistant | 1220 Caroline St Ne Ste A-230, Atlanta, GA 30307-2749 | 2020-03-12 |
| 1104463645 | Hannah Elyse Galvan | Physician Assistant | 550 Peachtree St Ne Bldg Rm3245a, Atlanta, GA 30308-2247 | 2019-12-03 |
| Find all providers in ATLANTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.