Malatrice Montgomery, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

005866 Issued in GA

Practice address

790 Church St NE Ste 400
Marietta, GA 30060-8957

Phone

(770) 405-2976

NPI assigned

Jun 7, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Quantum Radiology PCGroup PAC ID 4385543230, 105 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

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

• Quantum Radiology, PC

  • Diagnostic Radiology Physician
  • Marietta, GA
  • NPI 1366495988
  Medicare reassignment Care Compare group
• Radiology Associates of Dekalb PC

  • Diagnostic Radiology Physician
  • Decatur, GA
  • NPI 1245206119
  NPD (past)
• Wellstar Cardiovascular Medicine, LLC

  • Cardiovascular Disease Physician
  • Marietta, GA
  • NPI 1457320319
  NPD (past)

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

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1972823425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3157",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462063157",
            "telephone_number": "770-405-2976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 CHURCH ST NE STE 400",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608957",
            "telephone_number": "770-405-2976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1984 Peachtree Rd NW",
            "address_2": "Suite 505",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303095219",
            "country_code": "US",
            "telephone_number": "404-352-1409",
            "fax_number": "404-352-8176",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTGOMERY",
        "first_name": "MALATRICE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-07",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "005866",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "624861726",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Eduardo Montana Jr., MD MPH
• Freeman M Montaque, MD MPH
• Keri Monteiro
• Elizabeth M Montgomery
• Ginger Platte Montgomery, NP
• Monique Jena Montgomery
• Somjai Wendy Montgomery, LMT
• Zora Indigo Montgomery
• Ngozi Rosalin Monu, MD, PHD
• Samantha Moody, LPC, LMHC

• Physician Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.