Provider Demographics
NPI:1790491132
Name:MONTGOMERY, CARL WESLEY II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:WESLEY
Last Name:MONTGOMERY
Suffix:II
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:979 E 3RD ST STE C-520
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2136
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:979 E 3RD ST STE C-520
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2136
Practice Address - Country:US
Practice Address - Phone:423-778-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2023-01-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant