Healthcare Provider Details

I. General information

NPI: 1821077413
Provider Name (Legal Business Name): RICHARD MCCONNELL FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 10/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CORPORATE PARK DR
OPELIKA AL
36801-7283
US

IV. Provider business mailing address

2901 CORPORATE PARK DR
OPELIKA AL
36801-7283
US

V. Phone/Fax

Practice location:
  • Phone: 334-203-1766
  • Fax: 334-203-1784
Mailing address:
  • Phone: 334-203-1766
  • Fax: 334-203-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number5738
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: