Basic Information
| Provider Information | |||||||||
| NPI: | 1871779363 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | NICHOLE | ||||||||
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| Credential: | M.D,, M.P.H | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1364 CLIFTON RD NE | ||||||||
| Address2: | 3B SOUTH ROOM B-355 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007115444 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1364 CLIFTON RD NE | ||||||||
| Address2: | 3B SOUTH ROOM B-355 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007115444 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2008 | ||||||||
| LastUpdateDate: | 01/05/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 001474 | GA | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 060944 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.