Provider Demographics
NPI:1689658585
Name:FREEMAN, CORNELIUS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:EDWARD
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8513 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-6238
Mailing Address - Country:US
Mailing Address - Phone:912-351-0606
Mailing Address - Fax:912-351-0606
Practice Address - Street 1:8513 HEATHERWOOD DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-6238
Practice Address - Country:US
Practice Address - Phone:912-351-0606
Practice Address - Fax:912-351-0606
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030767204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00434618DGAMedicaid
GA00434618DGAMedicaid
GAD45379Medicare UPIN