MEDICARE: BRUCE PALMER FRESHLEY JR. MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	94991	GA
2	207QS0010X	Sports Medicine (Family Medicine) Physician	94991	GA
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207QS0010X	Sports Medicine (Family Medicine) Physician	82649	SC

General Provider Information

NPI Number	:	1033774633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUCE PALMER FRESHLEY JR. MD

Provider Business Mailing Address
First Line	:	506 E CHEVES ST STE 202
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29506-2616
Country	:	US
Telephone Number	:	843-390-0100
Fax Number	:	843-390-0038

Provider Business Practice Location Address
First Line	:	3793 MCDOWELL LANE
Second Line	:	STE 100
City	:	LITTLE RIVER
State	:	SC
Zip	:	29566-7892
Country	:	US
Telephone Number	:	843-390-0100
Fax Number	:	843-390-0038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2019
Last Update Date	:	09/18/2023

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