Provider Demographics
NPI:1730180233
Name:MONTGOMERY, WENDY SMITH (AUD)
Entity type:Individual
Prefix:DR
First Name:WENDY
Middle Name:SMITH
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1260 HIGHWAY 54 W
Mailing Address - Street 2:STE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4514
Mailing Address - Country:US
Mailing Address - Phone:770-631-1833
Mailing Address - Fax:770-461-9402
Practice Address - Street 1:181 UPPER RIVERDALE RD SW
Practice Address - Street 2:STE 1A
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4919
Practice Address - Country:US
Practice Address - Phone:770-996-2861
Practice Address - Fax:770-991-1604
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3152231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP01987Medicare UPIN
GA64BCBHWMedicare ID - Type Unspecified