Provider Demographics
NPI:1508087537
Name:FREEDOM MEDICAL SOLUTIONS, INC.
Entity Type:Organization
Organization Name:FREEDOM MEDICAL SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:678-817-7281
Mailing Address - Street 1:PO BOX 142905
Mailing Address - Street 2:49-B HUDSON PLAZA
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-6523
Mailing Address - Country:US
Mailing Address - Phone:678-817-7281
Mailing Address - Fax:678-817-7282
Practice Address - Street 1:49B HUDSON PLZ
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1658
Practice Address - Country:US
Practice Address - Phone:678-817-7281
Practice Address - Fax:678-817-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52048763OtherBLUE CROSS & BLUE SHIELD
GA52048763OtherBLUE CROSS & BLUE SHIELD
GA5117900001Medicare NSC
GA=========OtherTRICARE