Basic Information
| Provider Information | |||||||||
| NPI: | 1568414837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | DORIAN | ||||||||
| MiddleName: | PATRICE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 TREE LANE RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709720330 | ||||||||
| FaxNumber: | 7709852683 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 TREE LANE RD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | SNELLVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300786782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709720330 | ||||||||
| FaxNumber: | 7709852683 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | RN128290 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LW0102X | RN128290 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health | 364SP1700X | RN128290 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Perinatal |
ID Information
| ID | Type | State | Issuer | Description | RN128290 | 01 | GA | PROFESSIONAL NURSE LICENS | OTHER |