Provider Demographics
NPI:1730935651
Name:MONTGOMERY, ALYCIA (MD)
Entity type:Individual
Prefix:DR
First Name:ALYCIA
Middle Name:
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ALY
Other - Middle Name:
Other - Last Name:MONTGOMERY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2215 GARLAND AVE
Mailing Address - Street 2:LIGHT HALL STE 203
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-0019
Mailing Address - Country:US
Mailing Address - Phone:505-489-5028
Mailing Address - Fax:
Practice Address - Street 1:2215 GARLAND AVE
Practice Address - Street 2:LIGHT HALL STE 203
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-0019
Practice Address - Country:US
Practice Address - Phone:615-936-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program