Provider Demographics
NPI:1649267667
Name:FREEMAN, WILLIAM E (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
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 1:121 STEEPLECHASE RUN
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-2627
Mailing Address - Country:US
Mailing Address - Phone:478-953-0760
Mailing Address - Fax:
Practice Address - Street 1:136 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6300
Practice Address - Country:US
Practice Address - Phone:478-953-1020
Practice Address - Fax:478-953-5406
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026856174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000352965EMedicaid
GA07BDBFWMedicare ID - Type Unspecified
GAGRP4498Medicare ID - Type Unspecified
GA111134ASCAMedicare ID - Type UnspecifiedSURGERY CENTER