Provider Demographics
NPI:1609997733
Name:MCINTYRE, THOMAS JOSEPH (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3131
Mailing Address - Country:US
Mailing Address - Phone:770-985-0837
Mailing Address - Fax:770-985-6677
Practice Address - Street 1:2219 SCENIC DR
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3131
Practice Address - Country:US
Practice Address - Phone:770-985-0837
Practice Address - Fax:770-985-6677
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1012103T00000X
GA403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDQFMedicare PIN