Provider Demographics
NPI:1275621567
Name:MONTGOMERY, MARY COURTS (RD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:COURTS
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 RIDGEFORD CT
Mailing Address - Street 2:
Mailing Address - City:FUQUAY VARINA
Mailing Address - State:NC
Mailing Address - Zip Code:27526-9000
Mailing Address - Country:US
Mailing Address - Phone:919-552-0853
Mailing Address - Fax:
Practice Address - Street 1:2408 RIDGEFORD CT
Practice Address - Street 2:
Practice Address - City:FUQUAY VARINA
Practice Address - State:NC
Practice Address - Zip Code:27526-9000
Practice Address - Country:US
Practice Address - Phone:919-552-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL000863133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered