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General NPI Number Information
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NPI Number | 1659681880
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Entity Type | Organization
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Legal Business Name | MARK R. FUNK, M.D., L.L.C.
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 700 CENTER ST SUITE 503
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City | COLUMBUS
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State | GA
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Zip | 31901-1546
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Country | US
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Telephone | 706-322-0667
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Fax | 706-322-0873
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Provider Business Mailing Address
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Address Line | 700 CENTER ST SUITE 503
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City | COLUMBUS
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State | GA
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Zip | 31901-1546
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Country | US
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Telephone | 706-322-0667
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Fax | 706-322-0873
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Authorized Official
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Title or Position | OWNER
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Name | MARK R. FUNK
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Credential | M.D.
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Telephone | 706-322-0667
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 016510
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License Number State | GA
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