Individual
DR. KIMBERLY ANN FUNCHES-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1810 STADIUM DR, SUITE 210, PHENIX CITY, AL 36867-3177
(334) 297-1085
Mailing address
PO BOX 1045, PHENIX CITY, AL 36868-1045
(334) 291-5255
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
056705
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
056705
GA LICENSE
GA
01
—
26806
STATE MEDICAL LICENSE
AL
Enumeration date
05/11/2006
Last updated
02/27/2017
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