Provider Demographics
NPI:1851460265
Name:INTILI, HENRY SANTO (FNP)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:SANTO
Last Name:INTILI
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39818-0125
Mailing Address - Country:US
Mailing Address - Phone:229-246-1428
Mailing Address - Fax:229-246-1428
Practice Address - Street 1:268 MOCK CEMETERY RD
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39817-6904
Practice Address - Country:US
Practice Address - Phone:800-841-0858
Practice Address - Fax:800-841-0858
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN123672NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner