Provider Demographics
NPI:1073272647
Name:ODOM, MARLENE (CNA)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:ODOM
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 FALLS XING
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-8935
Mailing Address - Country:US
Mailing Address - Phone:679-459-8618
Mailing Address - Fax:
Practice Address - Street 1:45 FALLS XING
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-8935
Practice Address - Country:US
Practice Address - Phone:679-459-8618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide