Provider Demographics
NPI:1710331087
Name:FREEDOM FAMILY MEDICINE, P.A.
Entity Type:Organization
Organization Name:FREEDOM FAMILY MEDICINE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ASHLEY
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-991-6800
Mailing Address - Street 1:2519F AIRPORT BLVD NW UNIT F
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27896-9673
Mailing Address - Country:US
Mailing Address - Phone:252-991-6800
Mailing Address - Fax:252-991-6801
Practice Address - Street 1:2519F AIRPORT BLVD NW UNIT F
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27896-9673
Practice Address - Country:US
Practice Address - Phone:252-991-6800
Practice Address - Fax:252-991-6801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FREEDOM FAMILY MEDICINE PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty