Healthcare Provider Details

I. General information

NPI: 1083247951
Provider Name (Legal Business Name): AARON A MONTGOMERY NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2020
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 BRECKINRIDGE BLVD STE 200
DULUTH GA
30096-4959
US

IV. Provider business mailing address

1265 AUTUMN HILL LN
STONE MOUNTAIN GA
30083-5200
US

V. Phone/Fax

Practice location:
  • Phone: 404-728-4164
  • Fax:
Mailing address:
  • Phone: 860-459-5575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN277626
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN277626
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: