Provider Demographics
NPI:1740656818
Name:FREEMAN, KIMBERLY WILLEY (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:WILLEY
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 WOLF RIVER BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1779
Mailing Address - Country:US
Mailing Address - Phone:901-767-5000
Mailing Address - Fax:
Practice Address - Street 1:7550 WOLF RIVER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1779
Practice Address - Country:US
Practice Address - Phone:901-767-5000
Practice Address - Fax:901-767-6000
Is Sole Proprietor?:No
Enumeration Date:2015-08-12
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1740656818207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD0000036791OtherSTATE OF TENNESSEE