Provider Demographics
NPI:1508824095
Name:FREEDMAN, ARTHUR M (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:M
Last Name:FREEDMAN
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 1:1120 15TH ST STE BI1056
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0004
Mailing Address - Country:US
Mailing Address - Phone:706-721-3813
Mailing Address - Fax:706-721-8623
Practice Address - Street 1:1120 15TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-3040
Practice Address - Country:US
Practice Address - Phone:706-721-3813
Practice Address - Fax:706-721-8623
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC224182085R0202X
GA0821512085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89064GMMedicaid
SCT65694Medicaid
SCT65694Medicaid
SC300121048Medicare PIN
SCE493097895Medicare PIN
SCP00149141Medicare PIN
SCE493091324Medicare PIN