Individual
SARA BLAKELY MONTOYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
507 N LAUREL ST, SUMMERVILLE, SC 29483-6558
(843) 875-0600
(843) 871-3499
Mailing address
PO BOX 530062, ATLANTA, GA 30353-0062
(843) 572-7727
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14024
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080092632
RR MEDICARE
SC
05
—
140243
—
SC
Enumeration date
04/28/2006
Last updated
06/01/2023
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