Organization
MONA MED GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEFAN MONTGOMERY (CEO)
(803) 269-4965
Entity
Organization
Contact information
Practice address
8484 DORCHESTER RD, CHARLESTON, SC 29420-7319
(803) 269-4965
Mailing address
8484 DORCHESTER RD, CHARLESTON, SC 29420-7319
(803) 269-4965
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
27277
SC
Other
Enumeration date
12/14/2010
Last updated
12/14/2010
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