Individual
AMY ELISE FUNDERBURK MOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4100 AUSTIN PEAY HWY, MEMPHIS, TN 38128-2502
(901) 844-1431
Mailing address
PO BOX 770390, MEMPHIS, TN 38177-0390
(901) 844-1431
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD31772
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3843367
—
TN
Enumeration date
08/15/2005
Last updated
11/30/2023
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