Individual
DR. CHARLES A MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
109 E CHURCH ST, GREENEVILLE, TN 37745-5603
(423) 638-4131
(423) 638-9239
Mailing address
109 E CHURCH ST, GREENEVILLE, TN 37745-5603
(423) 638-4131
(423) 638-9239
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13954
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000039
—
TN
01
—
43425
TN BLUECARE
TN
Enumeration date
11/28/2006
Last updated
07/08/2007
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