Individual
IAN C MUNGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1497 FAIR RD, STATESBORO, GA 30458-0822
(912) 486-1111
Mailing address
1176 BRAMPTON AVE, STATESBORO, GA 30458-0847
(912) 259-9474
(912) 225-5719
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
070661
GA
207Q00000X
Family Medicine Physician
R-8762
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0230169
—
IA
Enumeration date
07/02/2009
Last updated
10/19/2020
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