Healthcare Provider Details

I. General information

NPI: 1780218123
Provider Name (Legal Business Name): AMBER FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 ROSS CLARK CIR STE 100
DOTHAN AL
36301-3023
US

IV. Provider business mailing address

3144 ROSS CLARK CIR
DOTHAN AL
36303-3038
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-1148
  • Fax:
Mailing address:
  • Phone: 334-791-3355
  • Fax: 334-923-4264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-145085
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: