Provider Demographics
NPI:1457572513
Name:FREEMAN, MAURICE JEROME (DMD)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:JEROME
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5070
Mailing Address - Street 2:
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-5070
Mailing Address - Country:US
Mailing Address - Phone:229-423-9308
Mailing Address - Fax:229-423-9309
Practice Address - Street 1:708 S GRANT ST
Practice Address - Street 2:BLDG 20
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-3788
Practice Address - Country:US
Practice Address - Phone:229-423-9308
Practice Address - Fax:229-423-9309
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010397122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist