Provider Demographics
NPI:1760520159
Name:MONTAG, JAMES W JR (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:MONTAG
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 BOONES CREEK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5165
Mailing Address - Country:US
Mailing Address - Phone:423-788-3080
Mailing Address - Fax:423-913-2810
Practice Address - Street 1:415 BOONES CREEK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5165
Practice Address - Country:US
Practice Address - Phone:423-788-3080
Practice Address - Fax:423-913-2810
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA787363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1517920Medicaid
TN1517920Medicaid
TNS09078Medicare UPIN