Provider Demographics
NPI:1558875328
Name:FREEMAN, JAMES EVERETTE JR
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EVERETTE
Last Name:FREEMAN
Suffix:JR
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 1:102 1ST ST SE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1554
Mailing Address - Country:US
Mailing Address - Phone:276-325-0139
Mailing Address - Fax:
Practice Address - Street 1:102 1ST ST SE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1554
Practice Address - Country:US
Practice Address - Phone:276-325-0139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
172A00000X
VAT64024638172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver