MEDICARE: JAMES W MONTAG JR. P.A.-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	PA787	TN

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	:	1760520159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES W MONTAG JR. P.A.-C

Provider Business Mailing Address
First Line	:	415 BOONES CREEK RD
Second Line	:	SUITE 1
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-5165
Country	:	US
Telephone Number	:	423-788-3080
Fax Number	:	423-913-2810

Provider Business Practice Location Address
First Line	:	415 BOONES CREEK RD
Second Line	:	SUITE 1
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-5165
Country	:	US
Telephone Number	:	423-788-3080
Fax Number	:	423-913-2810

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

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	05/02/2013

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