Healthcare Provider Details

I. General information

NPI: 1760890537
Provider Name (Legal Business Name): MONTGOMERY PSYCHIARY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 LONGFIELD CT
MONTGOMERY AL
36117-8055
US

IV. Provider business mailing address

1040 LONGFIELD CT
MONTGOMERY AL
36117-8055
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-9009
  • Fax: 334-288-9497
Mailing address:
  • Phone: 334-288-9009
  • Fax: 334-288-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD 15148
License Number StateAL

VIII. Authorized Official

Name: TERESA P DUFFEY
Title or Position: INSURANCE MANAGER
Credential:
Phone: 334-288-9009