Provider Demographics
NPI:1245393321
Name:WILLIAM E FREEMAN, MD
Entity Type:Organization
Organization Name:WILLIAM E FREEMAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-953-1020
Mailing Address - Street 1:136 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6300
Mailing Address - Country:US
Mailing Address - Phone:478-953-1020
Mailing Address - Fax:478-953-5406
Practice Address - Street 1:136 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6300
Practice Address - Country:US
Practice Address - Phone:478-953-1020
Practice Address - Fax:478-953-5406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026856207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA070002990OtherRAILROAD MEDICARE
GA000352965EMedicaid
GA026856OtherMEDICAL LICENSE
GAD45381Medicare UPIN
GA026856OtherMEDICAL LICENSE