Davidetta Freeman, SFA, CST

Primary specialty

Surgical AssistantTaxonomy code 246ZC0007X

License

155777 Issued in GA

Practice address

1473 Alamein Dr
Lawrenceville, GA 30046-2862

Phone

(678) 425-4568

Fax

(678) 403-0334

NPI assigned

Jun 8, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• DBF Surgical Assistant

  • Surgical Technologist
  • Lawrenceville, GA
  • NPI 1770945032
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1386024941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1473 ALAMEIN DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300462862",
            "telephone_number": "678-425-4344",
            "fax_number": "678-403-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1473 ALAMEIN DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300462862",
            "telephone_number": "678-425-4568",
            "fax_number": "678-403-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "DAVIDETTA",
        "credential": "SFA, CST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-08",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZC0007X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Surgical Assistant",
            "state": "GA",
            "license": "155777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael K Frech, LCSW
• Mirlande Frederic-St Hilaire
• Jolie Frederick
• Freedom Path Counseling Inc
• Charles Jordan Freeman, MD
• James Roe Freeman, M.D.
• Leslie S Freeman, PAAA
• Selena Freeman, MS, CCADC
• Taheerah D Freeman, FNP
• Douglas J Freiberger, M.D.

• Surgical Assistant in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Surgical Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.