Organization
PREVENTCLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID E. MONTGOMERY (OWNER/ PHYSICIAN)
(470) 735-5045
Entity
Organization
Contact information
Practice address
6000 LAKE FORREST DR STE 540, SANDY SPRINGS, GA 30328
(470) 735-5045
Mailing address
6000 LAKE FORREST DR STE 540, SANDY SPRINGS, GA 30328-5902
(470) 735-5045
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
405300000X
Prevention Professional
—
—
Other
Enumeration date
02/20/2018
Last updated
07/18/2018
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