Provider Demographics
NPI:1336140607
Name:FREEMAN, RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2864 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-5635
Mailing Address - Country:US
Mailing Address - Phone:770-693-2622
Mailing Address - Fax:770-693-6039
Practice Address - Street 1:111 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4157
Practice Address - Country:US
Practice Address - Phone:706-845-3920
Practice Address - Fax:706-845-3978
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0223672085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00273479AMedicaid
GA00273479AMedicaid