Provider Demographics
NPI:1982632428
Name:MCINTYRE, SHELLY (MD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 RIVER ST STE B
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3252
Mailing Address - Country:US
Mailing Address - Phone:706-896-7102
Mailing Address - Fax:706-896-7141
Practice Address - Street 1:120 RIVER ST STE B
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546
Practice Address - Country:US
Practice Address - Phone:706-896-7102
Practice Address - Fax:706-896-7141
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012392782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982632428Medicaid
VA170897Medicare UPIN