Provider Demographics
NPI:1992954440
Name:MATTHEW G FREEMAN MD LLC
Entity type:Organization
Organization Name:MATTHEW G FREEMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-913-2485
Mailing Address - Street 1:100 TOWNCENTER BLVD STE 113
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-1832
Mailing Address - Country:US
Mailing Address - Phone:205-409-0525
Mailing Address - Fax:260-969-6023
Practice Address - Street 1:100 TOWNCENTER BLVD STE 113
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-1832
Practice Address - Country:US
Practice Address - Phone:205-409-0525
Practice Address - Fax:260-969-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL27301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510G700380OtherMEDICARE PTAN