Healthcare Provider Details

I. General information

NPI: 1396793691
Provider Name (Legal Business Name): EVA YVONNE MONTGOMERY-MCGUIRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8052 MALL PKWY STE 104
STONECREST GA
30038-2649
US

IV. Provider business mailing address

8052 MALL PKWY STE 104
STONECREST GA
30038-2649
US

V. Phone/Fax

Practice location:
  • Phone: 678-528-2122
  • Fax:
Mailing address:
  • Phone: 678-528-2122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number65846
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: