Maurice Jerome Freeman, D.M.D.
Individual provider Active NPI Dentist · Fitzgerald, GA
NPI 1457572513 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1457572513
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 010397 (GA)
- Practice address
- 708 S Grant St
BLDG 20
Fitzgerald, GA 31750-3788 - Phone
- (229) 423-9308
- Fax
- (229) 423-9309
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 010397 | GA | Yes |
Addresses
Primary practice location
708 S Grant St
BLDG 20
Fitzgerald, GA 31750-3788
Mailing address
PO Box 5070
Fitzgerald, GA 31750-5070
Phone (229) 423-9308
Other providers in Fitzgerald, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.