Provider Demographics
NPI:1306357918
Name:MONTGOMERY, TAMMY WYNETT (MENTAL HEALTH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:WYNETT
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MENTAL HEALTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 12TH ST STE 801
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2485
Mailing Address - Country:US
Mailing Address - Phone:706-619-2869
Mailing Address - Fax:706-739-4815
Practice Address - Street 1:34 MISTY FOREST DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36869-7987
Practice Address - Country:US
Practice Address - Phone:580-917-6584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty