Provider Demographics
NPI:1760890537
Name:MONTGOMERY PSYCHIARY, PC
Entity Type:Organization
Organization Name:MONTGOMERY PSYCHIARY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:P
Authorized Official - Last Name:DUFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-288-9009
Mailing Address - Street 1:1040 LONGFIELD CT
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-8055
Mailing Address - Country:US
Mailing Address - Phone:334-288-9009
Mailing Address - Fax:334-288-9497
Practice Address - Street 1:1040 LONGFIELD CT
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-8055
Practice Address - Country:US
Practice Address - Phone:334-288-9009
Practice Address - Fax:334-288-9497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD 151482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510 86780OtherBLUE CROSS OF ALABAMA
AL511 44624OtherBLUE CROSS OF ALABAMA
AL102I509286Medicare PIN
AL0000 86780Medicare PIN