Provider Demographics
NPI:1871779363
Name:MCINTOSH, NICHOLE (MD,, MPH)
Entity type:Individual
Prefix:
First Name:NICHOLE
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MD,, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:3B SOUTH ROOM B-355
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:800-711-5444
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:3B SOUTH ROOM B-355
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1064
Practice Address - Country:US
Practice Address - Phone:800-711-5444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001474207L00000X
GA060944207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology