Provider Demographics
NPI:1194755827
Name:MONTGOMERY, BRENDELLA TURNBOW (MD)
Entity type:Individual
Prefix:DR
First Name:BRENDELLA
Middle Name:TURNBOW
Last Name:MONTGOMERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-7845
Mailing Address - Country:US
Mailing Address - Phone:256-325-3854
Mailing Address - Fax:
Practice Address - Street 1:139 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-7845
Practice Address - Country:US
Practice Address - Phone:256-325-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00017420207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF67202Medicare UPIN