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Individual

TAMEKA STACEY-ANN FUNNY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1333 TAYLOR ST, SUITE 6F, COLUMBIA, SC 29201-2923
(803) 296-3273
(803) 296-7061
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7303
(803) 296-7330

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
39903
SC
207RI0200X
Infectious Disease Physician
OS11222
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004076000
FL
01
14FV3
BCBSFL
FL
05
399037
SC
Enumeration date
08/09/2007
Last updated
03/16/2018
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