Healthcare Provider Details

I. General information

NPI: 1730751926
Provider Name (Legal Business Name): ANDREW EDWARD MONTGOMERY NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: DREW EDWARD MONTGOMERY NP-C

II. Dates (important events)

Enumeration Date: 07/15/2021
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 UNIVERSITY HOSPITAL DR
MOBILE AL
36617-2300
US

IV. Provider business mailing address

PO BOX 746450
ATLANTA GA
30374-6450
US

V. Phone/Fax

Practice location:
  • Phone: 251-471-7000
  • Fax: 251-470-7096
Mailing address:
  • Phone: 251-434-3626
  • Fax: 251-445-2464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-155828
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: