Individual
SIDRAH ODOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1833 CLIFTON RD NE, ATLANTA, GA 30329-4021
(678) 485-4273
Mailing address
1833 CLIFTON RD NE, ATLANTA, GA 30329-4021
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA002279
GA
Other
Enumeration date
11/29/2012
Last updated
11/29/2012
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