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General NPI Number Information
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NPI Number | 1336140607
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Entity Type | Individual
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Provider Name | RICHARD FREEMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 111 MEDICAL DR
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City | LAGRANGE
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State | GA
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Zip | 30240-4157
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Country | US
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Telephone | 706-845-3920
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Fax | 706-845-3978
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Provider Business Mailing Address
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Address Line | 2864 JOHNSON FERRY RD SUITE 150
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City | MARIETTA
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State | GA
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Zip | 30062-5635
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Country | US
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Telephone | 770-693-2622
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Fax | 770-693-6039
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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 | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 022367
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License Number State | GA
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