Provider Demographics
NPI:1780667865
Name:FREEMAN, MARK GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:979 E 3RD ST
Mailing Address - Street 2:SUITE C430
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:423-624-6584
Mailing Address - Fax:423-624-6588
Practice Address - Street 1:979 E 3RD ST
Practice Address - Street 2:SUITE C430
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-624-6584
Practice Address - Fax:423-624-6588
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00744207X00000X
TN37747207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901023Medicaid
SCN0074AMedicaid
NCI33084Medicare UPIN
NC2041692Medicare ID - Type Unspecified
NC5901023Medicaid
TN4582070001Medicare NSC
TN3822702Medicare PIN