Individual
DR. RICHARD D. ODOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Mailing address
1670 CLAIRMONT RD, DECATUR, GA 30033-4004
(404) 321-6111
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
812
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215584-01
CSHCN
TX
05
—
1215584-02
—
TX
01
—
480030644
RR/MEDICARE
TX
01
—
86J274
BLUE SHIELD
TX
Enumeration date
03/30/2006
Last updated
10/09/2012
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