Provider Demographics
NPI:1225071806
Name:MONTGOMERY, JAMES CLAFFY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:CLAFFY
Last Name:MONTGOMERY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4518 RICHMOND HILL DR
Mailing Address - Street 2:
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-6818
Mailing Address - Country:US
Mailing Address - Phone:843-908-3229
Mailing Address - Fax:843-947-0513
Practice Address - Street 1:4518 RICHMOND HILL DR
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-6818
Practice Address - Country:US
Practice Address - Phone:843-908-3229
Practice Address - Fax:843-947-0513
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8192207VG0400X
FL95662207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC081921Medicaid
SCD178033595Medicare ID - Type Unspecified
SCD17803Medicare UPIN