Provider Demographics
NPI:1780038547
Name:FREEDMAN, NICOLE LIZA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LIZA
Last Name:FREEDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIKKI
Other - Middle Name:LIZA
Other - Last Name:FREEDMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1364 CLIFTON RD NE STE BG20
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-712-4596
Mailing Address - Fax:404-712-1219
Practice Address - Street 1:1364 CLIFTON RD NE STE BG20
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1005
Practice Address - Country:US
Practice Address - Phone:404-712-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22553207R00000X, 390200000X
GA91789390200000X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program