Individual
JACK FREEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
743 SPRING ST NE, GAINESVILLE, GA 30501-3715
(770) 536-2146
Mailing address
PO BOX 2938, GAINESVILLE, GA 30503-2938
(770) 536-2146
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0097-01359
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000158463L
—
GA
05
—
891132K
—
NC
01
—
GRP4155
MEDICARE GROUP NUMBER
GA
Enumeration date
09/01/2006
Last updated
10/08/2008
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