Jackson Davis Montrym, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

96309 Issued in GA

Practice address

3580 Massee LN Ste F
Columbus, GA 31909-2586

Phone

(706) 596-8667

NPI assigned

Apr 10, 2020

Last updated

Jul 17, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/12280/brand/1/csg/1/fhir/r4
• FHIR API: https://fhir4.healow.com/fhir/r4/FCABED/Endpoint/FCABED
• Direct secure messaging: jackson.montrym.1@12280.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Devica Alappan MDPC

  • Pediatrics Physician
  • Columbus, GA
  • NPI 1871659656
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1508485426",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3580 MASSEE LN STE F",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319092586",
            "telephone_number": "706-596-8667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3580 MASSEE LN STE F",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319092586",
            "telephone_number": "706-596-8667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTRYM",
        "first_name": "JACKSON",
        "middle_name": "DAVIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-10",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "96309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Montgomery Vamc
• Montgomery Vamc
• Christian Sidney Maxwell Montgomery
• Maddison Montgomery, M.ED, BCBA
• Marcus Montgomery
• McKenna Moody, RBT
• Moon Road Cosmetic & Family Dentistry
• Jasmine S Moon
• Megan Marie Mooney, M.S., NCC
• John Moore Sr.

• Pediatrics Physician in Columbus, GA
• Providers in Columbus, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.