MEDICARE: JERRIE D FREEMAN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1003	GA

General Provider Information

NPI Number	:	1275535437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRIE D FREEMAN PA

Provider Business Mailing Address
First Line	:	290 YUMA TRL
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-5117
Country	:	US
Telephone Number	:	706-650-9878
Fax Number	:

Provider Business Practice Location Address
First Line	:	3614 J DEWEY GRAY CIR STE D
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-6512
Country	:	US
Telephone Number	:	706-868-7380
Fax Number	:	706-868-7223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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