Provider Demographics
NPI:1851949416
Name:ODOM, MADISON DAWN (PA-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:DAWN
Last Name:ODOM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3333 RIVERWOOD PKWY SE STE 250
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3304
Mailing Address - Country:US
Mailing Address - Phone:770-914-0116
Mailing Address - Fax:770-955-4278
Practice Address - Street 1:2985 MACK DOBBS RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-2641
Practice Address - Country:US
Practice Address - Phone:770-268-4011
Practice Address - Fax:470-251-6052
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA10775363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant