Individual
STEFAN L MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
853 N CHURCH ST, SUITE 510, SPARTANBURG, SC 29303-3098
(864) 560-6193
(864) 560-1510
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
27277
SC
207QS0010X
Sports Medicine (Family Medicine) Physician
27277
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272779
—
SC
01
—
AA05373365
MEDICARE PIN
SC
01
—
P01556670
RAILROAD MEDICARE
SC
Enumeration date
12/16/2005
Last updated
02/01/2021
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