ODELL JR. ANDERSON (PT) – Physical Therapist, NPI 1710549423

ODELL JR. ANDERSON (PT) is a healthcare provider. based in Fayetteville, Georgia. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT. They hold a License No. PT014062 (GA). The NPI Number for ODELL JR. ANDERSON (PT) is 1710549423

Main info

Male
7 Years Of Experience
Name
ODELL JR. ANDERSON (PT)
NPI
1710549423
Phone
(404) 994-7727
Address
290 HIGHWAY 314 STE B
Enumeration Date
2 July 2019
Last Update Date
2 July 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
4044586139
Graduation Year
2019 (7 years ago)
PAC ID
6305271214
Group Practice PAC ID
8628379997
Professional Enrollment ID
I20200123001719
Address ID
GA303443321EA2881XSTXX301
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:6State licenses:1Digital endpointsOther names

2,871 PHYSICAL THERAPIST IN PRIVATE PRACTICE in GA

Provider Addresses for ODELL JR. ANDERSON (PT)

  • 290 HIGHWAY 314 STE B

    FAYETTEVILLE, GA 302147813

    Phone: (404) 994-7727

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-01-23

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200123001719IPhysical Therapist In Private PracticeGATBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97113Therapy procedure using water pool to exercises, each 15 minutes78517$0
97530Therapy procedure using functional activities3015$0
97161Evaluation for physical therapy, typically 20 minutes1313$0
View full utilization report →

Insurance plans in this area (ZIP 30214)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 8628379997View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeGA
-GA
Occupational Therapist In Private PracticePA

Reviews

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Frequently asked questions

How is ODELL JR. ANDERSON (PT) identified in CMS data?
CMS-hosted NPPES data lists ODELL JR. ANDERSON (PT) with NPI 1710549423.
Is ODELL JR. ANDERSON (PT) still practicing?
ODELL JR. ANDERSON (PT) is currently listed as active in the public NPI registry.
What taxonomy line describes ODELL JR. ANDERSON (PT)?
For research purposes, treat ODELL JR. ANDERSON (PT) as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
Does ODELL JR. ANDERSON (PT) list a practice location?
Patients near Fayetteville, Georgia may find ODELL JR. ANDERSON (PT) in results; validate coverage separately.
Why does ODELL JR. ANDERSON (PT) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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