Provider Demographics
NPI:1346354925
Name:MCINTYRE, JEANNE M (CRNA)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 MIDDLE RD S
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-3436
Mailing Address - Country:US
Mailing Address - Phone:229-878-5019
Mailing Address - Fax:
Practice Address - Street 1:740 MIDDLE RD S
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-3436
Practice Address - Country:US
Practice Address - Phone:229-878-5019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA168577367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA915750892AMedicaid
GA43ZCBPF55Medicare ID - Type Unspecified
GA915750892AMedicaid