Individual
KEVIN MONTGOMERY
Active
Individual
KEVIN MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
005095
GA
101YM0800X
Mental Health Counselor
LPC010470
GA
363AM0700X
Medical Physician Assistant
Primary
12883
GA
Other
Enumeration date
10/09/2017
Last updated
11/03/2025
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