Provider Demographics
NPI:1427069806
Name:FREEMAN, KEVIN STEWART (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:STEWART
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 1:33 UPPER RIVERDALE RD SW
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2626
Mailing Address - Country:US
Mailing Address - Phone:770-991-1624
Mailing Address - Fax:770-991-9206
Practice Address - Street 1:33 UPPER RIVERDALE RD SW
Practice Address - Street 2:SUITE 114
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2626
Practice Address - Country:US
Practice Address - Phone:770-991-1624
Practice Address - Fax:770-991-9206
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA180012853OtherPALMETTO GBA
GA00468036AMedicaid
GA180012853OtherPALMETTO GBA
GA18BDCFNMedicare ID - Type Unspecified
GAE88381Medicare UPIN