Individual
MALISA FUNDERBURK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4330 S LEE ST STE 600, BUFORD, GA 30518-5795
(770) 648-2500
Mailing address
4992 PRICE DR, SUWANEE, GA 30024-4186
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
07/08/2022
Last updated
07/08/2022
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