Provider Demographics
NPI:1922072180
Name:TIMMS, MONTGOMERY RICKS (MD)
Entity Type:Individual
Prefix:MR
First Name:MONTGOMERY
Middle Name:RICKS
Last Name:TIMMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 EISENHOWER DR
Mailing Address - Street 2:#3
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-354-2104
Mailing Address - Fax:912-351-0598
Practice Address - Street 1:310 EISENHOWER DR
Practice Address - Street 2:#3
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-354-2104
Practice Address - Fax:912-351-0598
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA22899208600000X
SC27726208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00279452BMedicaid
GA00279452BMedicaid