Healthcare Provider Details

I. General information

NPI: 1073146536
Provider Name (Legal Business Name): HEATHER RENEE FREEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4875 FLOYD RD SW
MABLETON GA
30126-1379
US

IV. Provider business mailing address

4875 FLOYD RD SW
MABLETON GA
30126-1379
US

V. Phone/Fax

Practice location:
  • Phone: 770-745-3108
  • Fax: 770-745-9907
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number023552
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: