Provider Demographics
NPI:1639429061
Name:MONTES, MAURIANNE (LAC, MACOM)
Entity type:Individual
Prefix:
First Name:MAURIANNE
Middle Name:
Last Name:MONTES
Suffix:
Gender:
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 SHADOWLAWN DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-4074
Mailing Address - Country:US
Mailing Address - Phone:912-227-0263
Mailing Address - Fax:
Practice Address - Street 1:1201 SHADOWLAWN DR STE 106
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-4074
Practice Address - Country:US
Practice Address - Phone:912-227-0263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0807171100000X
GA570171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist