Provider Demographics
NPI:1447976022
Name:FREEDOM PATHOLOGY LLC
Entity type:Organization
Organization Name:FREEDOM PATHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:BRUKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-239-4235
Mailing Address - Street 1:PO BOX 16266
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2966
Mailing Address - Country:US
Mailing Address - Phone:912-239-4235
Mailing Address - Fax:
Practice Address - Street 1:4849 PAULSEN ST STE 212
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4425
Practice Address - Country:US
Practice Address - Phone:912-239-4235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory