Healthcare Provider Details

I. General information

NPI: 1942324025
Provider Name (Legal Business Name): MICHAEL W FREE LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 HIGHWAY 48
SUMMERVILLE GA
30747-1506
US

IV. Provider business mailing address

PO BOX 322
ROCK SPRING GA
30739-0322
US

V. Phone/Fax

Practice location:
  • Phone: 706-857-5441
  • Fax: 706-857-7607
Mailing address:
  • Phone: 706-375-3863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW002117
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: