| Doctor Name: | MRS. MARTHA MONTGOMERY |
| NPI Number: | 1003294760 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 261QA0600X |
| Business Practice Address: | 112 W Faris Rd Greenville, SC - 296053061 |
| Business Phone Number: | 4042900296 |
| Business Fax Number: | |
| Mailing Address: | 112 W Faris Rd, GREENVILLE |
| State: | SC |
| Postal Code: | 296053061 |
| Phone Number: | 4042900296 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2015 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | 261QA0600X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | SC |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |