Provider Demographics
NPI:1689667800
Name:FREEMAN, JENNIFER CORBITT (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:CORBITT
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BECKETT LANE
Mailing Address - Street 2:SUITE 506
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-7160
Mailing Address - Country:US
Mailing Address - Phone:678-817-6314
Mailing Address - Fax:678-817-6319
Practice Address - Street 1:101 BECKETT LANE
Practice Address - Street 2:SUITE 506
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-7160
Practice Address - Country:US
Practice Address - Phone:678-817-6314
Practice Address - Fax:678-817-6319
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041559174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000703249FMedicaid
GA511I160110Medicare PIN