Provider Demographics
NPI:1164396057
Name:MONTEZ, GARION ANDREA
Entity type:Individual
Prefix:
First Name:GARION
Middle Name:ANDREA
Last Name:MONTEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GARION
Other - Middle Name:ANDREA
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2674 CLOUD LN
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2258
Mailing Address - Country:US
Mailing Address - Phone:678-613-1654
Mailing Address - Fax:
Practice Address - Street 1:140 DECATUR ST SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3204
Practice Address - Country:US
Practice Address - Phone:404-413-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty