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General NPI Number Information
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NPI Number | 1699045823
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Entity Type | Individual
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Provider Name | AMBER NIKOLE FREEMAN PAC
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Gender | Female
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Dates
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Enumeration Date | 01/04/2012
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 26 PARKWAY DR
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-4248
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Country | US
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Telephone | 67-956-2846
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Fax | 706-956-2850
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Provider Business Mailing Address
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Address Line | 645 ANTELOPE BLVD STE 24
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City | RED BLUFF
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State | CA
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Zip | 96080-2463
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Country | US
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Telephone | 530-528-7650
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Fax | 530-528-7655
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9963
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA22028
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License Number State | CA
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