Individual
DANNY JONATHAN MONTENEGRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST # HB-4000, AUGUSTA, GA 30912-0004
(706) 721-3159
Mailing address
404 ARROWHEAD TRL, CANTON, GA 30114-6592
(678) 577-1429
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11986
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11986
RESIDENCY TRAINING PERMIT
GA
Enumeration date
06/12/2020
Last updated
06/12/2020
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