Individual
DR. ANGELA D ODOM-AUSTIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1140 S VIENNA ST, RUSTON, LA 71270-5834
(318) 224-7190
Mailing address
PO BOX 1230, HAMPTON, VA 23661-0230
(757) 247-1111
(757) 825-5740
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
0101047120
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2505637
—
LA
05
—
6754406
—
VA
Enumeration date
07/05/2006
Last updated
10/04/2019
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