Provider Demographics
NPI:1649820549
Name:FREEMAN, TRACCEY ANN
Entity type:Individual
Prefix:
First Name:TRACCEY
Middle Name:ANN
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4620 NARAYAN ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28227-6683
Mailing Address - Country:US
Mailing Address - Phone:704-606-2525
Mailing Address - Fax:
Practice Address - Street 1:4620 NARAYAN ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28227-6683
Practice Address - Country:US
Practice Address - Phone:704-606-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-13
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program