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General NPI Number Information
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NPI Number | 1285903567
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Entity Type | Organization
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Legal Business Name | MARYLAND FARMS PEDIATRICS
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Dates
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Enumeration Date | 12/15/2011
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Last Update Date | 12/15/2011
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Provider Practice Location Address
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Address Line | 5056 THOROUGHBRED LANE
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-373-3337
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Fax | 615-373-3782
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Provider Business Mailing Address
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Address Line | 5056 THOROUGHBRED LANE
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City | BRENTWOOD
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State | TN
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Zip | 37027
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Country | US
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Telephone | 615-373-3337
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Fax | 615-373-3782
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Authorized Official
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Title or Position | PEDIATRICIAN
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Name | DR. LEE ANN FREEMAN
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Credential | MD
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Telephone | 615-373-3337
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 31436
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 33870
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16962
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License Number State | TN
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