Provider Demographics
NPI:1972266906
Name:ODENIYI, CARLA RENAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:RENAE
Last Name:ODENIYI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:810 CLIFTON SPRINGS CLOSE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8727
Mailing Address - Country:US
Mailing Address - Phone:832-248-4643
Mailing Address - Fax:
Practice Address - Street 1:810 CLIFTON SPRINGS CLOSE DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-8727
Practice Address - Country:US
Practice Address - Phone:832-248-4643
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA232728163W00000X
GARN232728363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse