Provider Demographics
NPI:1396219077
Name:FREEMAN, JOSHUA NATHAN I
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:NATHAN
Last Name:FREEMAN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 HOMER ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-3425
Mailing Address - Country:US
Mailing Address - Phone:901-413-9080
Mailing Address - Fax:
Practice Address - Street 1:814 HOMER ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-3425
Practice Address - Country:US
Practice Address - Phone:901-413-9080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN107295356343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1264Medicaid