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General NPI Number Information
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NPI Number | 1386024941
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Entity Type | Individual
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Provider Name | DAVIDETTA FREEMAN SFA, CST
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Gender | Female
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Dates
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Enumeration Date | 06/08/2015
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Last Update Date | 06/08/2015
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Provider Practice Location Address
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Address Line | 1473 ALAMEIN DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-2862
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Country | US
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Telephone | 678-425-4568
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Fax | 678-403-0334
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Provider Business Mailing Address
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Address Line | 1473 ALAMEIN DR
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-2862
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Country | US
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Telephone | 678-425-4344
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Fax | 678-403-0334
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 155777
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License Number State | GA
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