Provider Demographics
NPI:1710144001
Name:WILLIAM J. MCINTOSH PHD PC
Entity Type:Organization
Organization Name:WILLIAM J. MCINTOSH PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-493-9777
Mailing Address - Street 1:1439 MCLENDON DR STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1841
Mailing Address - Country:US
Mailing Address - Phone:770-493-9777
Mailing Address - Fax:
Practice Address - Street 1:1439 MCLENDON DR STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1841
Practice Address - Country:US
Practice Address - Phone:770-493-9777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY000316103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDGXMedicare Oscar/Certification