Provider Demographics
NPI:1083006183
Name:MONTAGUE, JOSH
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:
Last Name:MONTAGUE
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 1:138 TANNENBAUM CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9687
Mailing Address - Country:US
Mailing Address - Phone:336-689-1067
Mailing Address - Fax:
Practice Address - Street 1:405 GUILFORD COLLEGE RD APT N
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-2063
Practice Address - Country:US
Practice Address - Phone:336-600-1220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC309922172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver