Provider Demographics
NPI:1437605300
Name:ODOM, SUMMER LORRAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:LORRAINE
Last Name:ODOM
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 MEREDYTH DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-2267
Mailing Address - Country:US
Mailing Address - Phone:229-883-7010
Mailing Address - Fax:
Practice Address - Street 1:140 GRAY MOSS RD
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:GA
Practice Address - Zip Code:31743-2218
Practice Address - Country:US
Practice Address - Phone:229-869-5483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN204070363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily