Individual
JUSTIN WALLACE ODGERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6379 CENTER DR, NORFOLK, VA 23502-4102
(757) 467-4200
Mailing address
403 24TH ST APT 11, VIRGINIA BEACH, VA 23451-3262
(413) 588-7344
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/13/2022
Last updated
02/28/2022
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