Provider Demographics
NPI:1417324484
Name:FREEMAN, CHARISMA (NP-C)
Entity Type:Individual
Prefix:
First Name:CHARISMA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6025 PROFESSIONAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5609
Mailing Address - Country:US
Mailing Address - Phone:678-504-7362
Mailing Address - Fax:678-244-3449
Practice Address - Street 1:6025 PROFESSIONAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5609
Practice Address - Country:US
Practice Address - Phone:678-504-7362
Practice Address - Fax:678-244-3449
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184104363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner