Provider Demographics
NPI:1225040264
Name:MONTGOMERY, GLYNDA HARDY (RD, LDN)
Entity Type:Individual
Prefix:
First Name:GLYNDA
Middle Name:HARDY
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 E RAINES RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6337
Mailing Address - Country:US
Mailing Address - Phone:901-271-4900
Mailing Address - Fax:901-271-4911
Practice Address - Street 1:1056 E RAINES RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6337
Practice Address - Country:US
Practice Address - Phone:901-271-4900
Practice Address - Fax:901-271-4911
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0531133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered