Healthcare Provider Details

I. General information

NPI: 1780667865
Provider Name (Legal Business Name): MARK GREGORY FREEMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

979 E 3RD ST SUITE C430
CHATTANOOGA TN
37403-2136
US

IV. Provider business mailing address

979 E 3RD ST SUITE C430
CHATTANOOGA TN
37403-2136
US

V. Phone/Fax

Practice location:
  • Phone: 423-624-6584
  • Fax: 423-624-6588
Mailing address:
  • Phone: 423-624-6584
  • Fax: 423-624-6588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2005-00744
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number37747
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: