Individual
DR. GORDON GLENN FREEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3891 HIGHWAY 78 W, SNELLVILLE, GA 30039-3932
(770) 972-4764
(770) 972-4164
Mailing address
3891 HIGHWAY 78 W, SNELLVILLE, GA 30039-3932
(770) 972-4764
(770) 972-4164
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
023958
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1568628618
GROUP NPI
—
01
—
4073314
AETNA PROVIDER ID
GA
01
—
52260821-001
BLUE CROSS BLUE SHIELD PROVIDER ID
GA
Enumeration date
06/02/2006
Last updated
08/19/2008
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