Provider Demographics
NPI:1023695707
Name:FREEMAN, JESSICA (PMHNP-BC, DNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PMHNP-BC, DNP
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:SPARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:506 N THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3625
Mailing Address - Country:US
Mailing Address - Phone:423-208-2290
Mailing Address - Fax:
Practice Address - Street 1:2945 MILLER FERRY RD SW
Practice Address - Street 2:SUITE 4
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-602-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-27
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215662163W00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty