Healthcare Provider Details

I. General information

NPI: 1275155517
Provider Name (Legal Business Name): CATHERINE GARFUNKEL MSN, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2020
Last Update Date: 05/09/2020
Certification Date: 05/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2765 RABBIT RIDGE RUN
VALDOSTA GA
31605-4369
US

IV. Provider business mailing address

2765 RABBIT RIDGE RUN
VALDOSTA GA
31605-4369
US

V. Phone/Fax

Practice location:
  • Phone: 410-271-9120
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN261926
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN261926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: