Provider Demographics
NPI:1962479279
Name:FREEMAN, RONALD ALLEN (MD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:ALLEN
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 1:800 1ST ST STE 240
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8308
Mailing Address - Country:US
Mailing Address - Phone:478-633-6900
Mailing Address - Fax:478-633-2175
Practice Address - Street 1:800 1ST ST
Practice Address - Street 2:STE 240
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8300
Practice Address - Country:US
Practice Address - Phone:478-633-6900
Practice Address - Fax:478-633-2175
Is Sole Proprietor?:No
Enumeration Date:2006-03-06
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010930208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010930OtherGA LICENSE
GA000135275BMedicaid
GA023204OtherBLUE CROSS OF GA
GA00135275BMedicaid
GA00135275BMedicaid