Provider Demographics
NPI:1164448452
Name:MCINTOSH, ABRAHAM STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:STEVEN
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1269 WELLBROOK CIR NE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-3873
Mailing Address - Country:US
Mailing Address - Phone:770-922-0505
Mailing Address - Fax:770-922-1870
Practice Address - Street 1:1269 WELLBROOK CIR NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3873
Practice Address - Country:US
Practice Address - Phone:770-922-0505
Practice Address - Fax:770-922-1870
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA46667207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00885398BMedicaid
GA10BBCKZMedicare ID - Type Unspecified
GAF46836Medicare UPIN