Provider Demographics
NPI:1437974300
Name:ODELUS WELLNESS PSYCHIATRY
Entity type:Organization
Organization Name:ODELUS WELLNESS PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ODELUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-594-5277
Mailing Address - Street 1:358 RYSTON WAY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-2523
Mailing Address - Country:US
Mailing Address - Phone:404-839-8412
Mailing Address - Fax:
Practice Address - Street 1:358 RYSTON WAY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-2523
Practice Address - Country:US
Practice Address - Phone:470-594-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty