Healthcare Provider Details

I. General information

NPI: 1275557290
Provider Name (Legal Business Name): GREGORY E. FREEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 COLLEGE ST
HOGANSVILLE GA
30230-1114
US

IV. Provider business mailing address

100 COLLEGE ST
HOGANSVILLE GA
30230-1114
US

V. Phone/Fax

Practice location:
  • Phone: 706-637-6125
  • Fax: 706-637-6129
Mailing address:
  • Phone: 706-637-6125
  • Fax: 706-637-6129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9502
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: