Provider Demographics
NPI:1598194912
Name:GUNTER, ODEA SONJA (LPN)
Entity Type:Individual
Prefix:
First Name:ODEA
Middle Name:SONJA
Last Name:GUNTER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 EMMET RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:GA
Mailing Address - Zip Code:30620-5603
Mailing Address - Country:US
Mailing Address - Phone:470-330-3599
Mailing Address - Fax:
Practice Address - Street 1:3471 EMMET RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-5603
Practice Address - Country:US
Practice Address - Phone:470-330-3599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2022-07-05
Deactivation Date:2018-05-09
Deactivation Code:
Reactivation Date:2022-06-08
Provider Licenses
StateLicense IDTaxonomies
GALPN089156164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse