Provider Demographics
NPI:1366589707
Name:WAKEFIELD, FREDDIE JAMES JR (DMD)
Entity type:Individual
Prefix:DR
First Name:FREDDIE
Middle Name:JAMES
Last Name:WAKEFIELD
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1650 OAKBROOK DR
Mailing Address - Street 2:STE 440
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093
Mailing Address - Country:US
Mailing Address - Phone:770-448-1030
Mailing Address - Fax:770-446-8000
Practice Address - Street 1:6568 TARA BLVD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-961-2000
Practice Address - Fax:770-961-9692
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA111521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice