Healthcare Provider Details

I. General information

NPI: 1730266750
Provider Name (Legal Business Name): CHERYL JEAN FREEMAN RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 BOULEVARD NE 3RD FLOOR
ATLANTA GA
30312
US

IV. Provider business mailing address

1880 SHIRBURN CIRCLE
RIVERDALE GA
30296
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-5835
  • Fax: 404-730-1633
Mailing address:
  • Phone: 770-991-4812
  • Fax: 770-991-4812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN040618
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: