Provider Demographics
NPI:1013341486
Name:FREEMAN, LILLIAN L (LPN)
Entity Type:Individual
Prefix:MISS
First Name:LILLIAN
Middle Name:L
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16103 SKYLINE LN NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-7915
Mailing Address - Country:US
Mailing Address - Phone:404-207-6664
Mailing Address - Fax:770-452-4470
Practice Address - Street 1:16103 SKYLINE LN NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30345-7915
Practice Address - Country:US
Practice Address - Phone:404-207-6664
Practice Address - Fax:770-452-4470
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPN050956164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse