Provider Demographics
NPI:1972266906
Name:ODENIYI, CARLA RENAE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:RENAE
Last Name:ODENIYI
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:MISS
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:173 BOULEVARD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1468
Mailing Address - Country:US
Mailing Address - Phone:404-658-1500
Mailing Address - Fax:
Practice Address - Street 1:173 BOULEVARD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1468
Practice Address - Country:US
Practice Address - Phone:404-658-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN232728363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health