Provider Demographics
NPI:1437485422
Name:FUNSTON, NADINE GUEDIRI (DC)
Entity Type:Individual
Prefix:DR
First Name:NADINE
Middle Name:GUEDIRI
Last Name:FUNSTON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 LAKESHORE DR
Mailing Address - Street 2:STE B
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3856
Mailing Address - Country:US
Mailing Address - Phone:912-510-9355
Mailing Address - Fax:
Practice Address - Street 1:102 MARSH HARBOUR PKWY STE 105
Practice Address - Street 2:
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548-6755
Practice Address - Country:US
Practice Address - Phone:404-384-2417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008475111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor