Provider Demographics
NPI:1639314453
Name:FUNNYE, WILLIE BENJAMIN
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:BENJAMIN
Last Name:FUNNYE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229 ROLLING HILL LN
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-1935
Mailing Address - Country:US
Mailing Address - Phone:803-469-4944
Mailing Address - Fax:803-469-4344
Practice Address - Street 1:515 BROAD ST
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-3354
Practice Address - Country:US
Practice Address - Phone:803-469-4944
Practice Address - Fax:803-469-4344
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-08
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)