Individual
KEVIN MAXWELL MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1752
Mailing address
809 82ND PKWY, MYRTLE BEACH, SC 29572-4607
(843) 692-1752
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
92030
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2019
Last updated
07/25/2022
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