Individual provider Active NPI

Kavon Dominick Freeman

  • Physical Therapist
  • Atlanta, GA
National Provider Identifier
1780595553
Registry record updated Sep 12, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT017637 Issued in GA
Practice address
2401 Cumberland Pkwy SE
Atlanta, GA 30339-1808
Phone
(770) 670-4184
NPI assigned
Sep 12, 2026
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 12, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT017637 GA Primary

Addresses

Primary practice location

2401 Cumberland Pkwy SE
Atlanta, GA 30339-1808

Mailing address

4381 Pipemaker BLF
Douglasville, GA 30135-8219
Phone (404) 423-9929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI Registry JSON

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

{
    "created_epoch": "1789171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789171200000",
    "number": "1780595553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4381 PIPEMAKER BLF",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301358219",
            "telephone_number": "404-423-9929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 CUMBERLAND PKWY SE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303391808",
            "telephone_number": "770-670-4184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FREEMAN",
        "first_name": "KAVON",
        "middle_name": "DOMINICK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2026-09-12",
        "last_updated": "2026-09-12",
        "certification_date": "2026-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT017637",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.

Verify at the official NPI Registry.