Healthcare Provider Details

I. General information

NPI: 1073174603
Provider Name (Legal Business Name): FREEDOM MOBILITY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4717 US HIGHWAY 80 E STE 7A
SAVANNAH GA
31410-2943
US

IV. Provider business mailing address

110 TALBERT POINTE DR
MOORESVILLE NC
28117-4377
US

V. Phone/Fax

Practice location:
  • Phone: 704-608-6155
  • Fax:
Mailing address:
  • Phone: 704-658-0817
  • Fax: 704-658-0936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JOHN GILBERT COTHAM
Title or Position: CEO
Credential:
Phone: 704-658-0817