=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548299365
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTGOMERY PSYCHIATRY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2006
-----------------------------------------------------
Last Update Date | 07/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1040 LONGFIELD CT
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-8055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-288-9009
-----------------------------------------------------
Fax | 334-288-9497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 LONGFIELD CT
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36117-8055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 334-288-9009
-----------------------------------------------------
Fax | 334-288-9497
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | WILLIAM C. FREEEMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 334-288-9009
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------