Provider Demographics
NPI:1376171645
Name:MONTAGUE, JONATHAN C
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:C
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 1:1828 LONG MILL RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27596-9178
Mailing Address - Country:US
Mailing Address - Phone:919-728-0195
Mailing Address - Fax:215-344-5087
Practice Address - Street 1:1828 LONG MILL RD
Practice Address - Street 2:
Practice Address - City:YOUNGSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27596-9178
Practice Address - Country:US
Practice Address - Phone:919-728-0195
Practice Address - Fax:215-344-5087
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347E00000XTransportation ServicesTransportation Broker