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General NPI Number Information
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NPI Number | 1437268125
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Entity Type | Individual
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Provider Name | ROBERT W MONTGOMERY PHD
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Gender | Male
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 11/18/2021
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Provider Practice Location Address
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Address Line | 107 WEATHERSTONE DR SUITE 530
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City | WOODSTOCK
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State | GA
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Zip | 30188
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Country | US
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Telephone | 770-591-9552
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Fax | 800-218-8249
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Provider Business Mailing Address
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Address Line | 107 WEATHERSTONE DR STE 530
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City | WOODSTOCK
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State | GA
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Zip | 30188-7006
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Country | US
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Telephone | 770-591-9552
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Fax | 800-218-8249
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-03-1376
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY001980
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License Number State | GA
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