Provider Demographics
NPI:1730364282
Name:FIELDER, ODICIE OKEDA (MD)
Entity type:Individual
Prefix:MRS
First Name:ODICIE
Middle Name:OKEDA
Last Name:FIELDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ODICIE
Other - Middle Name:OKEDA
Other - Last Name:FIELDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PEDMONT ROAD, NE
Mailing Address - Street 2:NINE PEIDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-504-5678
Mailing Address - Fax:
Practice Address - Street 1:2400 MT. ZION PARKWAY
Practice Address - Street 2:KAISER PERMANENTE SOUTHWOODE MEDICAL CENTER
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:626-817-2496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002166207R00000X
GA061065207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA002166OtherLICENSE NUMBER