Individual
GWENDOLYN ELAINE MONTGOMERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
3962 BUSBY MILL CT, ELLENWOOD, GA 30294-2052
(404) 314-7295
Mailing address
3962 BUSBY MILL CT, ELLENWOOD, GA 30294-2052
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
RN176860
GA
Other
Enumeration date
05/23/2019
Last updated
11/27/2023
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