Samantha Odom, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-22-58690 Issued in GA

Practice address

9559 Highway 5 Ste 601
Douglasville, GA 30135-1572

Phone

(470) 632-5276

Fax

(317) 520-8200

NPI assigned

Mar 25, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1648166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708560000000",
    "number": "1366192056",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 DEPAUW BLVD STE 3070",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462686135",
            "telephone_number": "855-324-0885",
            "fax_number": "317-520-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9559 HIGHWAY 5 STE 601",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351572",
            "telephone_number": "470-632-5276",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ODOM",
        "first_name": "SAMANTHA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-25",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-22-58690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Oasis Primary Care Clinic
• Kolade Kehinde Obajuluwa, M.D.
• Mark Lapitan Obana, PT, DPT
• Naa Y Oden, BCBA, NCSP
• Oluwaseun Odewole, MD,MPH
• Valerie M Odom
• Samuel Kevin Odum, DPT
• Ernest Ofori, PHARM D
• Briana Ogando, RBT
• Goziam Ogwu, LPC

• Behavior Analyst in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.