SAMUEL KEVIN ODUM (DPT) – Physical Therapist, NPI 1851136147
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,870 PHYSICAL THERAPIST IN PRIVATE PRACTICE in GA
Provider Addresses for SAMUEL KEVIN ODUM (DPT)
120 Cunningham Dr Ste F
Carrollton, GA 301172818
Phone: (678) 664-1467
Type: Location
2000 Mirror Lake Blvd Ste S
Villa Rica, GA 301802126
Phone: (770) 456-7877
Type: Location
500 Nathan Dean Blvd Ste 108
Dallas, GA 301574912
Phone: (678) 402-7770
Type: Location
2000 MIRROR LAKE BLVD STE S
VILLA RICA, GA 301802126
Phone: (770) 456-7877
Fax: (770) 456-7880
Type: Mailing
2983 CHAPEL HILL RD STE 106
DOUGLASVILLE, GA 301351767
Phone: (770) 947-8177
Fax: (770) 947-8377
Type: Location
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: 2024-08-21
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20240821000433 | I | Physical Therapist In Private Practice | GA | TBD |
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.
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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 30117)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | GA | |
| - | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA | |
| Physical Therapist In Private Practice | GA |
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