Healthcare Provider Details

I. General information

NPI: 1760520159
Provider Name (Legal Business Name): JAMES W MONTAG JR. P.A.-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BOONES CREEK RD SUITE 1
JONESBOROUGH TN
37659-5165
US

IV. Provider business mailing address

415 BOONES CREEK RD SUITE 1
JONESBOROUGH TN
37659-5165
US

V. Phone/Fax

Practice location:
  • Phone: 423-788-3080
  • Fax: 423-913-2810
Mailing address:
  • Phone: 423-788-3080
  • Fax: 423-913-2810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA787
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: