Provider Demographics
NPI:1477866820
Name:NEW SOUTH MEDICAL ENTERPRISES
Entity Type:Organization
Organization Name:NEW SOUTH MEDICAL ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-645-5595
Mailing Address - Street 1:2503 HIGHWAY 41A BYP
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3902
Mailing Address - Country:US
Mailing Address - Phone:931-645-5595
Mailing Address - Fax:931-645-5596
Practice Address - Street 1:2503 HIGHWAY 41A BYP
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-3902
Practice Address - Country:US
Practice Address - Phone:931-645-5595
Practice Address - Fax:931-645-5596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN029433207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty