Provider Demographics
NPI:1356439541
Name:MCINTIRE, JEFFREY N (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:N
Last Name:MCINTIRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2438
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-2438
Mailing Address - Country:US
Mailing Address - Phone:770-531-2444
Mailing Address - Fax:770-534-9877
Practice Address - Street 1:1250 JESSE JEWELL PKWY SE STE 500
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3865
Practice Address - Country:US
Practice Address - Phone:770-531-2444
Practice Address - Fax:770-534-9877
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0331422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89066X8Medicaid
GA000429701EMedicaid
GA000429701FMedicaid
GA1457553968OtherRAILROAD MEDICARE GROUP NPI#
GAGRP7496OtherMEDICARE GRP PROV #
GA1356439541OtherRAILROAD MEDICARE
GA000429701EMedicaid
GA000429701FMedicaid