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General NPI Number Information
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NPI Number | 1093675613
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Entity Type | Organization
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Legal Business Name | FREETOWN FAMILY CLINIC LLC
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Dates
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Enumeration Date | 11/15/2025
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Last Update Date | 11/15/2025
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Provider Practice Location Address
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Address Line | 100 OWINGS CT STE 8
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City | REISTERSTOWN
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State | MD
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Zip | 21136-3045
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Country | US
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Telephone | 443-653-0459
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Fax | 410-702-7470
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Provider Business Mailing Address
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Address Line | 4 SHASTA CIR APT F
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3720
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Country | US
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Telephone | 443-653-0459
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GIBRILLA SANNOH
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Credential |
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Telephone | 443-653-0459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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