Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Chisom Chijioke Odogwu

Individual provider Physician Assistant · NPI 1346801362

Chisom Chijioke Odogwu is a Physician Assistant in Stockbridge, Georgia. Qualified in 2019, 7 years ago. Practices with Northside Surgical Professional Services LLC, a 368-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
7
Licensed in
GA
In the registry since
2019
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Practice location Address checks out

135 N Park Pl Ste 101
Stockbridge, GA 30281-7237
Phone: (770) 758-7493
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 9389 (GA)

Record details

NPI number1346801362
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJune 21, 2019
Last updated in NPPESFebruary 19, 2024
Certification dateFebruary 19, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Northside Surgical Professional Services Llc — 368 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in Stockbridge