Individual
KATHLEEN G FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1606
(404) 851-6936
Mailing address
PO BOX 2968, KENNESAW, GA 30156-9117
(770) 779-0015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
037997
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000779688
—
GA
05
—
000779688C
—
GA
05
—
000779688D
—
GA
01
—
10038142
AMERIGROUP
GA
01
—
10472
KAISER
GA
01
—
202976
BCBS OF GEORGIA
GA
01
—
333404
WELLCARE OF GEORGIA
GA
01
—
920400
BCBS OF GEORGIA
GA
Enumeration date
02/14/2006
Last updated
12/19/2008
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