Provider Demographics
NPI:1003941725
Name:FREEMAN, ADAM REED (EDS, ATC)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:REED
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:EDS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 THUNDER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-2220
Mailing Address - Country:US
Mailing Address - Phone:770-966-9354
Mailing Address - Fax:
Practice Address - Street 1:4500 DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-3855
Practice Address - Country:US
Practice Address - Phone:678-594-8104
Practice Address - Fax:678-594-8106
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0005602255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer