Active NPI
Lakenya Odom
- Dermatology Physician
- Decatur, GA
National Provider Identifier
1548649387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- License
- CO1099990
- Practice address
- 18004 Anwar TRL
Decatur, GA 30032-7414 - Phone
- (678) 668-4183
- NPI assigned
- May 26, 2015
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | CO1099990 | GA | Primary |
Addresses
Primary practice location
18004 Anwar TRL
Decatur, GA 30032-7414
Mailing address
18004 Anwar TRL
Decatur, GA 30032-7414
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CO1099990 | GA | MD | Dermatology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1432598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432598400000",
"number": "1548649387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18004 ANWAR TRL",
"city": "DECATUR",
"state": "GA",
"postal_code": "300327414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18004 ANWAR TRL",
"city": "DECATUR",
"state": "GA",
"postal_code": "300327414",
"telephone_number": "678-668-4183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ODOM",
"first_name": "LAKENYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-05-26",
"last_updated": "2015-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "",
"desc": "Dermatology",
"state": "GA",
"license": "CO1099990",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.