Provider Information for 1437775194
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Dr. MONTGOMERY CALBERT PRESCOD PhD, NCC, BC-TMH
Sex: Male
NPI: 1437775194
Last Updated: 2020-06-18
Certification Date: 2020-06-18
Certification Date: 2020-06-18
Details
| Name | Value | ||||||||
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| NPI | 1437775194 | ||||||||
| Enumeration Date | 2020-06-18 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 80 EDGEWOOD DR ST MATTHEWS, SC 29135-8465 United States Phone: 917-584-1236 | Fax: | ||||||||
| Primary Practice Address | 110 YE OLDE KINGS HWY NORTH MYRTLE BEACH, SC 29582-4384 United States Phone: 843-663-0770 | Fax: | ||||||||
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