Healthcare Provider Details

I. General information

NPI: 1346064961
Provider Name (Legal Business Name): CHADE MONTGOMERY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2024
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST STE 203
FAYETTEVILLE NC
28305-5641
US

IV. Provider business mailing address

606 SPENCE ENCLAVE WAY
NASHVILLE TN
37210-3225
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-14865
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: