Individual
GRETCHEN SUZANNE MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-6175
(601) 200-2020
Mailing address
516 TWIN CEDARS DR, MADISON, MS 39110-7288
(601) 278-3269
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
18545
MS
207P00000X
Emergency Medicine Physician
C175540
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05957798
—
MS
Enumeration date
06/20/2006
Last updated
07/26/2023
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