Provider Demographics
NPI:1497732135
Name:FREEMAN, STEPHANIE E (MD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 742616
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-2616
Mailing Address - Country:US
Mailing Address - Phone:770-219-9000
Mailing Address - Fax:
Practice Address - Street 1:743 SPRING ST NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3715
Practice Address - Country:US
Practice Address - Phone:770-219-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425934207RC0200X
FLME129619207RC0200X
IN01079866A207RC0200X
WI71814207RC0200X
TXP4444207RC0200X, 207R00000X
KY41891207RC0200X
LA342951207RC0200X
IL036143725207RC0200X
IDM-10598207RC0200X
GA91041207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100116980Medicaid
PA101253245Medicaid
PA1729503OtherHIGHMARK
WI100095648Medicaid
PA090728Medicare ID - Type UnspecifiedHGSADMINISTRATORS
PA101253245Medicaid