Healthcare Provider Details

I. General information

NPI: 1164052072
Provider Name (Legal Business Name): MEGAN FREEMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2020
Last Update Date: 01/20/2020
Certification Date: 01/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 GRAYSON HWY
GRAYSON GA
30017-1245
US

IV. Provider business mailing address

1911 GRAYSON HWY
GRAYSON GA
30017-1245
US

V. Phone/Fax

Practice location:
  • Phone: 770-237-5352
  • Fax:
Mailing address:
  • Phone: 770-237-5352
  • Fax: 770-237-5351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number026669
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: