Chauncy Montgomery

NPI #1790094241 in Vidalia, Georgia

Provider Information

NPI Number: 1790094241
Entity Type: Organization
Organization Name: Chauncy Montgomery
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Oct 1, 2010
Last Updated: Oct 1, 2010

Practice Location

Address: 1114 JR ROLLINS RD
City: Vidalia
State: Georgia
ZIP Code: 30474-9462
Phone: (912) 537-4143

Authorized Official

Name: MRS. CHAUNCY DENETTE MONTGOMERY
Title: OWNER/DIRECTOR
Phone: (912) 347-2399

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Respite Care	385H00000X
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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