MEDICARE: CHADE MONTGOMERY PA-C

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	363AM0700X	Medical Physician Assistant	0010-14865	NC
2	363A00000X	Physician Assistant	0010-14865	NC

General Provider Information

NPI Number	:	1346064961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHADE MONTGOMERY PA-C

Provider Business Mailing Address
First Line	:	606 SPENCE ENCLAVE WAY
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37210-3225
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2301 ROBESON ST STE 203
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-5641
Country	:	US
Telephone Number	:	910-615-3220
Fax Number	:

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

Provider Enumeration Date	:	11/11/2024
Last Update Date	:	05/05/2026

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Directions to “ CHADE MONTGOMERY PA-C” Practice Location

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