Provider Demographics
NPI:1164650768
Name:JAMES M FREEMONT SR MD MHA PC
Entity Type:Organization
Organization Name:JAMES M FREEMONT SR MD MHA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREEMONT
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-768-3487
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-768-3487
Mailing Address - Fax:404-768-1051
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-768-3487
Practice Address - Fax:404-768-1051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016343207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00117752FMedicaid
GAD39901Medicare UPIN