Provider Demographics
NPI:1730196882
Name:MONTGOMERY, GARY L (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:L
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 LAKE HEARN DR
Mailing Address - Street 2:STE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:404-252-7339
Mailing Address - Fax:404-257-0337
Practice Address - Street 1:1100 LAKE HEARN DR
Practice Address - Street 2:STE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:404-252-7339
Practice Address - Fax:404-257-0337
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2024-08-22
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Provider Licenses
StateLicense IDTaxonomies
GA0340952080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E46667Medicare UPIN