Healthcare Provider Details

I. General information

NPI: 1760479836
Provider Name (Legal Business Name): JOSEPH H MONTGOMERY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 UNIVERSITY AVE
PARSONS TN
38363-2972
US

IV. Provider business mailing address

PO BOX 278
PARSONS TN
38363-0278
US

V. Phone/Fax

Practice location:
  • Phone: 731-847-6010
  • Fax: 731-847-6011
Mailing address:
  • Phone: 731-847-6010
  • Fax: 731-847-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number023682
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: