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General NPI Number Information
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NPI Number | 1215144282
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Entity Type | Organization
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Legal Business Name | MONTGOMERY FAMILY HEALTH CENTER INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 727 S, MAIN STREET
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City | MIDDLETON
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State | TN
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Zip | 38052
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Country | US
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Telephone | 731-376-2804
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Fax | 731-376-2806
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Provider Business Mailing Address
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Address Line | 727 S, MAIN STREET
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City | MIDDLETON
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State | TN
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Zip | 38052
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Country | US
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Telephone | 731-376-2804
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Fax | 731-376-2806
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CHARLOTTE MONTGOMERY
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Credential | APN
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Telephone | 731-376-2804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000005776
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License Number State | TN
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