=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306895198
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW GLENN FREEMAN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2006
-----------------------------------------------------
Last Update Date | 03/15/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 21950 STATE HIGHWAY 181 STE A
-----------------------------------------------------
City | FAIRHOPE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36532-4393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-621-6520
-----------------------------------------------------
Fax | 251-621-6521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 749429
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30374-9429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 257-621-6520
-----------------------------------------------------
Fax | 251-621-6521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 00025836
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------