MEDICARE: MONTGOMERY OBSTETRICAL & GYNECOLOGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	17893	AL
2	174400000X	Specialist	24720	AL

General Provider Information

NPI Number	:	1174602080
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY OBSTETRICAL & GYNECOLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	2173 NORMANDIE DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2728
Country	:	US
Telephone Number	:	334-284-2355
Fax Number	:	334-284-2141

Provider Business Practice Location Address
First Line	:	2173 NORMANDIE DRIVE
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36111-2728
Country	:	US
Telephone Number	:	334-284-2355
Fax Number	:	334-284-2141

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	BARBARA WARREN
Credential	:
Telephone Number	:	334-284-2355

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/22/2020

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