MEDICARE: DR. DEBORAH G MONTGOMERY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	14151	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00002737	OTHER	TN	R/R MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B04592	OTHER	TN	HEALTHSPRING
2	P3078319	OTHER	TN	FIRST HEALTH
3	4060491	OTHER	TN	BCBS
5	2183251	OTHER	TN	CIGNA
6	4119718	OTHER	TN	AETNA
7	4060491	OTHER	TN	TENNCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194779009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH G MONTGOMERY M.D.

Provider Business Mailing Address
First Line	:	5653 FRIST BLVD
Second Line	:	SUITE 630
City	:	HERMITAGE
State	:	TN
Zip	:	37076-2062
Country	:	US
Telephone Number	:	615-391-3971
Fax Number	:	615-345-0942

Provider Business Practice Location Address
First Line	:	5653 FRIST BLVD
Second Line	:	SUITE 630
City	:	HERMITAGE
State	:	TN
Zip	:	37076-2062
Country	:	US
Telephone Number	:	615-391-3971
Fax Number	:	615-345-0942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	02/20/2008

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Directions to “ DR. DEBORAH G MONTGOMERY M.D.” Practice Location

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