Active NPI
Jonathan Larry Odom
- Physician Assistant
- Norfolk, VA
National Provider Identifier
1497619282
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 0110012239
- Practice address
- 301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065 - Phone
- (757) 252-9140
- Fax
- (757) 793-4149
- NPI assigned
- Dec 15, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0110012239 | VA | Primary |
Addresses
Primary practice location
301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065
Mailing address
301 Riverview Ave Ste 202a
Norfolk, VA 23510-1065
Phone (757) 252-9140
Other practice location 1
7650 Cameron Ct
Mobile, AL 36695-4463
Phone (251) 422-7199
Other practice location 2
1080 First Colonial Rd Ste 400
Virginia Beach, VA 23454-2406
Phone (757) 395-8720
Other practice location 3
4000 Coliseum Dr Ste 200A
Hampton, VA 23666-5975
Phone (757) 736-1520
Other practice location 4
6251 E Virginia Beach Blvd Ste 300
Norfolk, VA 23502-2800
Phone (757) 252-9140
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1765756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788825600000",
"number": "1497619282",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 RIVERVIEW AVE STE 202A",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235101065",
"telephone_number": "757-252-9140",
"fax_number": "757-793-4149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 RIVERVIEW AVE STE 202A",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235101065",
"telephone_number": "757-252-9140",
"fax_number": "757-793-4149"
}
],
"practiceLocations": [
{
"address_1": "7650 Cameron Ct",
"address_purpose": "LOCATION",
"city": "Mobile",
"state": "AL",
"postal_code": "366954463",
"country_code": "US",
"telephone_number": "251-422-7199",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1080 First Colonial Rd Ste 400",
"address_purpose": "LOCATION",
"city": "Virginia Beach",
"state": "VA",
"postal_code": "234542406",
"country_code": "US",
"telephone_number": "757-395-8720",
"fax_number": "757-395-8821",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4000 Coliseum Dr Ste 200A",
"address_purpose": "LOCATION",
"city": "Hampton",
"state": "VA",
"postal_code": "236665975",
"country_code": "US",
"telephone_number": "757-736-1520",
"fax_number": "757-756-5116",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "6251 E Virginia Beach Blvd Ste 300",
"address_purpose": "LOCATION",
"city": "Norfolk",
"state": "VA",
"postal_code": "235022800",
"country_code": "US",
"telephone_number": "757-252-9140",
"fax_number": "757-793-4149",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ODOM",
"first_name": "JONATHAN",
"middle_name": "LARRY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-12-15",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": "VA",
"license": "0110012239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.