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General NPI Number Information
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NPI Number | 1033400478
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Entity Type | Organization
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Legal Business Name | FREDOM NOW MEDICAL, PLLC
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Dates
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Enumeration Date | 04/19/2011
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 9635 SOUTHERN PINE BLVD # 129
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City | CHARLOTTE
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State | NC
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Zip | 28273-5558
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Country | US
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Telephone | 704-641-4976
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Fax |
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Provider Business Mailing Address
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Address Line | 9635 SOUTHERN PINE BLVD # 129
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City | CHARLOTTE
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State | NC
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Zip | 28273-5558
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Country | US
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Telephone | 704-641-4976
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PROF. ALMAZ JOHNSON
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Credential | NP
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Telephone | 704-641-4976
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5004249
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License Number State | NC
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