MEDICARE: ALLISON LEIGH FREEMAN APRN

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	RN265464	GA

General Provider Information

NPI Number	:	1538894951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON LEIGH FREEMAN APRN

Provider Business Mailing Address
First Line	:	1011 WEST AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3312
Country	:	US
Telephone Number	:	404-219-4631
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 WHEELER RD STE 365
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3350
Country	:	US
Telephone Number	:	706-432-8775
Fax Number	:

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

Provider Enumeration Date	:	07/20/2022
Last Update Date	:	07/20/2022

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