Montgomery, Gretchen Suzanne

Montgomery, Gretchen Suzanne is an individual health care provider with primary practice located at 969 Lakeland Dr , Jackson MS 39216-4606. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as her primary health care specialty. Montgomery, Gretchen Suzanne can be contacted via phone (601) 200-6175.

Contact Information

Primary practice address
969 Lakeland Dr Jackson MS 39216-4606
Phone: (601) 200-6175
Fax: (601) 200-2020
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X C175540 California
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 18545 Mississippi

Profile Details

NPI number 1932145067
LBN Legal business name Montgomery, Gretchen Suzanne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 20th, 2006
Last updated Jul 26th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1932145067 NPPES
Mississippi MEDICAID 05957798

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