MEDICARE: COURTNEY FREEMAN

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	363A00000X	Physician Assistant
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1184487282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY FREEMAN

Provider Business Mailing Address
First Line	:	1117 ROOKERY DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7009
Country	:	US
Telephone Number	:	304-841-1091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1117 ROOKERY DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-7009
Country	:	US
Telephone Number	:	304-841-1091
Fax Number	:

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

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “ COURTNEY FREEMAN ” Practice Location

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