Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 035954 | GA |
NPI | 1174554588 |
---|---|
Provider Name | Eduardo Montana JR. |
First Address | Marietta, GA 30060 |
Second Address | Marietta, GA 30060 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 23/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000712962Y | (05) | GA |
G34198 | (02) |