Provider Demographics
NPI:1679981211
Name:HOWELL-FRECKLETON, ANNIE ROSE (ANP)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:ROSE
Last Name:HOWELL-FRECKLETON
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 MONTREAL ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6931
Mailing Address - Country:US
Mailing Address - Phone:678-580-6931
Mailing Address - Fax:770-807-0978
Practice Address - Street 1:1462 MONTREAL ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6931
Practice Address - Country:US
Practice Address - Phone:678-580-6931
Practice Address - Fax:770-807-0978
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN183877363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003156391AMedicaid
GA003156391DMedicaid
GA003156391AMedicaid
GA003156391DMedicaid