Samuel Kevin Odum, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT017179 Issued in GA

Practice address

2983 Chapel Hill Rd Ste 106
Douglasville, GA 30135-1767

Phone

(770) 947-8177

Fax

(770) 947-8377

NPI assigned

Jun 27, 2024

Sex

Male

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

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Independent Physical Therapy of Georgia, LLCGroup PAC ID 2961312244, 526 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Independent Physical Therapy of Georgia, LLC

  • Physical Therapist
  • Fort Oglethorpe, GA
  • NPI 1780636068
  Medicare reassignment Care Compare group
• Accel Physical Therapy Inc

  • Physical Therapist
  • Villa Rica, GA
  • NPI 1184827495
  Medicare reassignment NPD
• Benchmark Physical Therapy, Inc

  • Physical Therapy Clinic/Center
  • Duluth, GA
  • NPI 1083666903
  Medicare reassignment
• Agilitas USA Inc

  • Physical Therapy Clinic/Center
  • Hixson, TN
  • NPI 1962417444

  GA

  Medicare reassignment

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1851136147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 MIRROR LAKE BLVD STE S",
            "city": "VILLA RICA",
            "state": "GA",
            "postal_code": "301802126",
            "telephone_number": "770-456-7877",
            "fax_number": "770-456-7880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2983 CHAPEL HILL RD STE 106",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301351767",
            "telephone_number": "770-947-8177",
            "fax_number": "770-947-8377"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Cunningham Dr Ste F",
            "address_purpose": "LOCATION",
            "city": "Carrollton",
            "state": "GA",
            "postal_code": "301172818",
            "country_code": "US",
            "telephone_number": "678-664-1467",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "500 Nathan Dean Blvd Ste 108",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "GA",
            "postal_code": "301574912",
            "country_code": "US",
            "telephone_number": "678-402-7770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2000 Mirror Lake Blvd Ste S",
            "address_purpose": "LOCATION",
            "city": "Villa Rica",
            "state": "GA",
            "postal_code": "301802126",
            "country_code": "US",
            "telephone_number": "770-456-7877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ODUM",
        "first_name": "SAMUEL",
        "middle_name": "KEVIN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT017179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Lapitan Obana, PT, DPT
• Naa Y Oden, BCBA, NCSP
• Oluwaseun Odewole, MD,MPH
• Samantha Odom, BCBA
• Valerie M Odom
• Ernest Ofori, PHARM D
• Briana Ogando, RBT
• Goziam Ogwu, LPC
• Noelle Ohara, DPT
• Onyinye Ohia

• Physical Therapist in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.