Healthcare Provider Details

I. General information

NPI: 1245158666
Provider Name (Legal Business Name): EMMANUEL MICAYAH FUNCHESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10327 US 15 501 N UNIT R
CHAPEL HILL NC
27517-6467
US

IV. Provider business mailing address

180 BPW CLUB RD
CARRBORO NC
27510-2589
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone: 336-675-2998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: