Provider Demographics
NPI:1144650516
Name:FREEMAN, LARRY STEVEN JR (ARRT (R), CNMT)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:STEVEN
Last Name:FREEMAN
Suffix:JR
Gender:M
Credentials:ARRT (R), CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 WINDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5958
Mailing Address - Country:US
Mailing Address - Phone:423-926-6978
Mailing Address - Fax:
Practice Address - Street 1:JAMES H. QUILLEN VA MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3414
Is Sole Proprietor?:No
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN526609247100000X
MN337987247100000X
GA0377752471N0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA037775OtherNUCLEAR MEDICINE TECHNOLOGY CERTIFICATION BOARD (NMTCB), NATIONAL CERTIFICATION
TNMDX0000008167OtherCERTIFIED MEDICAL X-RAY TECHNOLOGIST
MN337987OtherTHE AMERICAN REGISTRY OF RADIOLOGIC TECHNOLOGIST (ARRT), NATIONAL CERTIFICATION