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General NPI Number Information
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NPI Number | 1346064961
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Entity Type | Individual
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Provider Name | CHADE MONTGOMERY PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/11/2024
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 2301 ROBESON ST STE 203
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-5641
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Country | US
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Telephone | 910-615-3220
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Fax |
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Provider Business Mailing Address
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Address Line | 606 SPENCE ENCLAVE WAY
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City | NASHVILLE
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State | TN
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Zip | 37210-3225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-14865
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License Number State | NC
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