Healthcare Provider Details

I. General information

NPI: 1932278652
Provider Name (Legal Business Name): OB-GYN ASSOCIATES OF MONTGOMERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 TAYLOR RD
MONTGOMERY AL
36117-3513
US

IV. Provider business mailing address

495 TAYLOR RD
MONTGOMERY AL
36117-3513
US

V. Phone/Fax

Practice location:
  • Phone: 334-279-9333
  • Fax: 334-279-9057
Mailing address:
  • Phone: 334-279-9333
  • Fax: 334-279-9057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: LEIGH ANN BROOKS
Title or Position: OFFICE MANAGER
Credential:
Phone: 334-279-9333