Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | F1114091 | GA |
NPI | 1003205345 |
---|---|
Provider Name | Janika Montgomery |
First Address | Atlanta, GA 30315-1640 |
Second Address | Atlanta, GA 30303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2015 |
Last Update Date | 17/03/2018 |