Provider Demographics
NPI:1326493289
Name:FUNK, BLAIR (MD)
Entity type:Individual
Prefix:DR
First Name:BLAIR
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1525 BUFORD HWY
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3665
Mailing Address - Country:US
Mailing Address - Phone:770-945-1699
Mailing Address - Fax:770-945-1698
Practice Address - Street 1:21731 N 77TH AVE STE 1300
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2109
Practice Address - Country:US
Practice Address - Phone:002-338-3264
Practice Address - Fax:623-561-3305
Is Sole Proprietor?:No
Enumeration Date:2016-04-28
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD61422193207Q00000X
NC2024-01311207Q00000X
AZ58464207Q00000X
GA81892207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine