Provider Demographics
NPI:1376369330
Name:MONTGOMERY, DAVID MARCUS (RN)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MARCUS
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 HEBRON DR
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TN
Mailing Address - Zip Code:38069-8114
Mailing Address - Country:US
Mailing Address - Phone:205-266-3272
Mailing Address - Fax:
Practice Address - Street 1:990 HEBRON DR
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TN
Practice Address - Zip Code:38069-8114
Practice Address - Country:US
Practice Address - Phone:205-266-3272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN116379163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse