Michael D Funderburk, MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

34138 Issued in GA

Practice address

1557 Janmar Rd
Snellville, GA 30078-5686

Phone

(678) 344-8900

Fax

(678) 666-5201

NPI assigned

Dec 7, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA, AL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ecm Health Group LLC

  • Obstetrics & Gynecology Physician
  • Florence, AL
  • NPI 1346588852

  Urology

  Medicare reassignment NPD
• Advanced Urology Institute of Georgia

  • Urology Physician
  • Snellville, GA
  • NPI 1073896510
  NPD
• Advanced Urology Institute of Georgia, PC

  • Urology Physician
  • Dallas, GA
  • NPI 1811846348
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576108800000",
    "number": "1326023938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1557 JANMAR RD",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785686",
            "telephone_number": "678-344-8900",
            "fax_number": "678-666-5201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1557 JANMAR RD",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300785686",
            "telephone_number": "678-344-8900",
            "fax_number": "678-666-5201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-07",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "034138",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "GA",
            "license": "34138",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000456332G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacelyn Frierson, DNP, APRN, CPNP-PC
• Alexandra Fuetterer, RBT
• Crystal Fuller
• Deborah E. Fuller
• Nicaler Pashanna Fuller
• Dariasz Raphviale Furlow, CERTIFIED NURSE AIDE
• Jenna Corinne Coon Fussell, MD
• David Charles Futral, D.C.
• Selassie Fynn, RN
• G.L. Farrow O.D. , P.C.

• Urology Physician in Snellville, GA
• Providers in Snellville, GA by specialty
• Urology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.