Healthcare Provider Details

I. General information

NPI: 1972824506
Provider Name (Legal Business Name): JAMES DAVID FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 08/17/2024
Certification Date: 08/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 TOKEN CT
KATHLEEN GA
31047-4114
US

IV. Provider business mailing address

1303 AZALEA CT STE C
MYRTLE BEACH SC
29577-5765
US

V. Phone/Fax

Practice location:
  • Phone: 706-969-9694
  • Fax:
Mailing address:
  • Phone: 352-265-0291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME123857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: