Provider Demographics
NPI:1124550736
Name:MONTGOMERY, KALLAN SIAN (MD)
Entity type:Individual
Prefix:DR
First Name:KALLAN
Middle Name:SIAN
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KALLAN
Other - Middle Name:SIAN
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1285 WAIANUENUE AVE
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1209
Mailing Address - Country:US
Mailing Address - Phone:808-932-3940
Mailing Address - Fax:808-933-0011
Practice Address - Street 1:1401 GEORGIAN PARK STE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-6974
Practice Address - Country:US
Practice Address - Phone:770-632-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-21180207Q00000X
GA94701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine