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General NPI Number Information
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NPI Number | 1467488551
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Entity Type | Individual
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Provider Name | SAMUEL JACOB MONTGOMERY JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 22995 US HIGHWAY 76
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City | CLINTON
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State | SC
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Zip | 29325-7529
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Country | US
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Telephone | 864-654-6706
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 896189
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City | CHARLOTTE
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State | NC
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Zip | 28289-6189
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Country | US
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Telephone | 864-654-6706
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Fax | 864-833-0520
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 20855
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License Number State | SC
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