Healthcare Provider Details

I. General information

NPI: 1821276874
Provider Name (Legal Business Name): MONTGOMERY PSYCHIATRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2008
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 FRIENDSHIP RD SECOND F LOOR
TALLASSEE AL
36078-1234
US

IV. Provider business mailing address

PO BOX 780774
TALLASSEE AL
36078-0008
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15148
License Number StateAL

VIII. Authorized Official

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