Provider Demographics
NPI:1669961272
Name:MONTGOMERY, MARGIE (NP)
Entity type:Individual
Prefix:MRS
First Name:MARGIE
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4061 VINEVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-5039
Mailing Address - Country:US
Mailing Address - Phone:478-757-0221
Mailing Address - Fax:478-757-4911
Practice Address - Street 1:4061 VINEVILLE AVE
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-5039
Practice Address - Country:US
Practice Address - Phone:478-757-0221
Practice Address - Fax:478-757-4911
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN122322363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily