1306933528 NPI number — JENNIFER CORBITT FREEMAN, M.D., P.C.

Table of content: (NPI 1306933528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306933528 NPI number — JENNIFER CORBITT FREEMAN, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER CORBITT FREEMAN, M.D., P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PAVILION WOMEN'S CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306933528
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 BECKETT LN
Provider Second Line Business Mailing Address:
SUITE 506
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-7160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-817-6314
Provider Business Mailing Address Fax Number:
678-817-6319

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BECKETT LN
Provider Second Line Business Practice Location Address:
SUITE 506
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30214-7160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-817-6314
Provider Business Practice Location Address Fax Number:
678-817-6319
Provider Enumeration Date:
10/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
OLIVIA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-817-6314

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  41559 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000703249F , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75325 . This is a "BCBS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 2327205 . This is a "AETNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 312419 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4717925 . This is a "CIGNA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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