Provider Demographics
NPI:1831117746
Name:MCINTOSH CLINIC, P.C.
Entity Type:Organization
Organization Name:MCINTOSH CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-225-1900
Mailing Address - Street 1:119 W HILL ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6618
Mailing Address - Country:US
Mailing Address - Phone:229-225-1900
Mailing Address - Fax:229-225-3461
Practice Address - Street 1:119 W HILL ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6618
Practice Address - Country:US
Practice Address - Phone:229-225-1900
Practice Address - Fax:229-225-3461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039824207N00000X
GA043430207N00000X
GA044161207N00000X
GA031427207R00000X
GA044213207R00000X
GA045191207R00000X
GA027373207R00000X
GA027459207R00000X
GA010526207R00000X
GA034272207RP1001X
GA034186207RR0500X
GA035335207ZD0900X
GA0568672084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Not Answered207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathologyGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD39777Medicare UPIN
GAF78323Medicare UPIN
GAD50474Medicare UPIN
GAD50628Medicare UPIN
GAS48718Medicare UPIN
GAS92386Medicare UPIN
GAG33730Medicare UPIN
GAG66306Medicare UPIN
GAE83157Medicare UPIN
GAH12407Medicare UPIN
GAG05876Medicare UPIN
FLA90853Medicare UPIN
GAD46318Medicare UPIN
GAD29452Medicare UPIN
GAE90424Medicare UPIN