MEDICARE: MONTGOMERY MEDICAL ASSOCIATES

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669990081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY MEDICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	35 COLLIER RD NW STE 185
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1671
Country	:	US
Telephone Number	:	404-590-0626
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 COLLIER RD NW STE 185
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30309-1671
Country	:	US
Telephone Number	:	404-590-0626
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERIKA NEWMAN
Credential	:	D.O.
Telephone Number	:	954-931-9714

Provider Enumeration Date	:	09/06/2017
Last Update Date	:	09/11/2019

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Directions to “MONTGOMERY MEDICAL ASSOCIATES ” Practice Location

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