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General NPI Number Information
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NPI Number | 1144650516
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Entity Type | Individual
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Provider Name | LARRY STEVEN FREEMAN JR. ARRT (R), CNMT
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Gender | Male
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 11/20/2013
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Provider Practice Location Address
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Address Line | JAMES H. QUILLEN VA MEDICAL CENTER
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City | MOUNTAIN HOME
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State | TN
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Zip | 37684
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Country | US
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Telephone | 423-926-1171
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Fax | 423-979-3414
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Provider Business Mailing Address
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Address Line | 2702 WINDWOOD DR
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City | JOHNSON CITY
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State | TN
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Zip | 37604-5958
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Country | US
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Telephone | 423-926-6978
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 526609
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | 337987
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License Number State | MN
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Taxonomy #3
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Taxonomy Code | 2471N0900X
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Taxonomy Name | Nuclear Medicine Technology Radiologic Technologist
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License Number | 037775
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License Number State | GA
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