Basic Information
| Provider Information | |||||||||
| NPI: | 1891302113 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FREEMAN | ||||||||
| FirstName: | JHYTAJHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | BA, RBT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2158 CUMBERLAND PKWY SE APT 2202 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303394545 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9192578252 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4000 SMITHTOWN RD | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300246559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4706324990 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2020 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | 20135182 | GA | Y |
ID Information
| ID | Type | State | Issuer | Description | 20135182 | 01 | GA | RBT | OTHER |