Individual
JEREMIAH R MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2604 MEDICAL OFFICE PL, GOLDSBORO, NC 27534-9417
(919) 580-0004
(919) 580-9099
Mailing address
2604 MEDICAL OFFICE PL, GOLDSBORO, NC 27534-9417
(919) 580-0004
(919) 580-9099
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
103911
NC
363AM0700X
Medical Physician Assistant
103911
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
103911
LICENSE
NC
01
—
Q01227
UPIN
—
Enumeration date
10/18/2005
Last updated
06/05/2024
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