Provider Demographics
NPI:1154886414
Name:MONTGOMERY, AUGUST DESHAE
Entity type:Individual
Prefix:
First Name:AUGUST
Middle Name:DESHAE
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CUMBERLAND SQ # 3046
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-3408
Mailing Address - Country:US
Mailing Address - Phone:931-302-5984
Mailing Address - Fax:
Practice Address - Street 1:1 CUMBERLAND SQ # 3046
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-3408
Practice Address - Country:US
Practice Address - Phone:931-302-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-31
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer