Provider Demographics
NPI:1407941578
Name:MCINTOSH, LISA M (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:ADE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2292 DALTON DR
Mailing Address - Street 2:STE C
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-8961
Mailing Address - Country:US
Mailing Address - Phone:931-645-5595
Mailing Address - Fax:931-645-5596
Practice Address - Street 1:2292 DALTON DR STE C
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-8961
Practice Address - Country:US
Practice Address - Phone:931-645-5595
Practice Address - Fax:931-645-5596
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
TNMD 029433207VG0400X
TN029433207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1477866820OtherNPI GROUP
1952792111OtherGROUP NPI
TN1477866820OtherNPI GROUP