Healthcare Provider Details

I. General information

NPI: 1386692812
Provider Name (Legal Business Name): JAMES ROE FREEMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD SUITE 300
LAWRENCEVILLE GA
30045-8708
US

IV. Provider business mailing address

2142 LIBERTY BELL PL
LAWRENCEVILLE GA
30043-4926
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-1340
  • Fax:
Mailing address:
  • Phone: 770-338-0052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number024238
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: