Provider Demographics
NPI:1801112859
Name:MONTAGUE, EDWIN CLARK (DO)
Entity type:Individual
Prefix:
First Name:EDWIN
Middle Name:CLARK
Last Name:MONTAGUE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:420 E 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3210
Mailing Address - Country:US
Mailing Address - Phone:706-509-3000
Mailing Address - Fax:706-509-6516
Practice Address - Street 1:304 TURNER MCCALL BLVD SW
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-5621
Practice Address - Country:US
Practice Address - Phone:706-509-5000
Practice Address - Fax:404-778-1401
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2023-04-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0694812080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine