Doctor Name: | JANIKA MONTGOMERY |
NPI Number: | 1003205345 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | F1114091 |
Business Practice Address: | 1046 Ridge Ave Sw Atlanta, GA - 303151640 |
Business Phone Number: | 4046881350 |
Business Fax Number: | |
Mailing Address: | 1046 Ridge Ave Sw, ATLANTA |
State: | GA |
Postal Code: | 303151640 |
Phone Number: | 4046881350 |
Fax Number: | |
NPI Enumeration Date: | 01/09/2015 |
NPI Last Update Date: | 04/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | F1114091 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |