Healthcare Provider Details

I. General information

NPI: 1356188833
Provider Name (Legal Business Name): JAMES ETHAN FREEMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 RIVIERA DR
CHAPPELLS SC
29037-8961
US

IV. Provider business mailing address

884 RIVIERA DR
CHAPPELLS SC
29037-8961
US

V. Phone/Fax

Practice location:
  • Phone: 864-992-5185
  • Fax:
Mailing address:
  • Phone: 864-992-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number32035
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: