Provider Demographics
NPI:1689113854
Name:MONTGOMERY, JOHN DAVIS JR (DRIVER)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DAVIS
Last Name:MONTGOMERY
Suffix:JR
Gender:M
Credentials:DRIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1275 KRISWOOD LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228
Mailing Address - Country:US
Mailing Address - Phone:614-900-7714
Mailing Address - Fax:
Practice Address - Street 1:1275 KRISWOOD LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-3462
Practice Address - Country:US
Practice Address - Phone:614-900-7714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver