Provider Demographics
NPI:1174554588
Name:MONTANA, EDUARDO JR (MD MPH)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:MONTANA
Suffix:JR
Gender:M
Credentials:MD MPH
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Mailing Address - Street 1:61 WHITCHER ST
Mailing Address - Street 2:STE 4140
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060
Mailing Address - Country:US
Mailing Address - Phone:404-943-0289
Mailing Address - Fax:404-943-9787
Practice Address - Street 1:61 WHITCHER ST
Practice Address - Street 2:STE 4140
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:404-943-0289
Practice Address - Fax:404-943-9787
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0359542080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000712962YMedicaid
GA000712962YMedicaid