Provider Demographics
NPI:1598846719
Name:FREEMAN, GARRETT D (PA-C)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:D
Last Name:FREEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:835 COGBURN AVE NW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1031
Mailing Address - Country:US
Mailing Address - Phone:770-422-5557
Mailing Address - Fax:770-422-5456
Practice Address - Street 1:2045 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-1327
Practice Address - Country:US
Practice Address - Phone:770-502-0202
Practice Address - Fax:770-502-8822
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA003875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00397375OtherRAILROAD MEDICARE
GAP86828Medicare UPIN
GA97WCHGQMedicare PIN