Provider Demographics
NPI:1699045823
Name:FREEMAN, AMBER NIKOLE (PAC)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:NIKOLE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 ANTELOPE BLVD STE 24
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2463
Mailing Address - Country:US
Mailing Address - Phone:530-528-7650
Mailing Address - Fax:530-528-7655
Practice Address - Street 1:26 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4248
Practice Address - Country:US
Practice Address - Phone:067-956-2846
Practice Address - Fax:706-956-2850
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9963363AM0700X
CAPA22028363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical