1730180233 NPI number — DR. WENDY SMITH MONTGOMERY AUD

Table of content: DR. WENDY SMITH MONTGOMERY AUD (NPI 1730180233)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730180233 NPI number — DR. WENDY SMITH MONTGOMERY AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
WENDY
Provider Middle Name:
SMITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730180233
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1260 HIGHWAY 54 W
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30214-4514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-631-1833
Provider Business Mailing Address Fax Number:
770-461-9402

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
181 UPPER RIVERDALE RD SW
Provider Second Line Business Practice Location Address:
STE 1A
Provider Business Practice Location Address City Name:
RIVERDALE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30274-4919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-996-2861
Provider Business Practice Location Address Fax Number:
770-991-1604
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  3152 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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