Provider Demographics
NPI:1922435551
Name:FREEMAN, EBONY GERALDINE
Entity Type:Individual
Prefix:MISS
First Name:EBONY
Middle Name:GERALDINE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 GRAVES RD APT 1406
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-5965
Mailing Address - Country:US
Mailing Address - Phone:337-787-2903
Mailing Address - Fax:
Practice Address - Street 1:1780 GRAVES RD APT 1406
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30093-5965
Practice Address - Country:US
Practice Address - Phone:337-787-2903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies