Provider Demographics
NPI:1245992163
Name:MCINTOSH, JENNELL (DPT)
Entity type:Individual
Prefix:DR
First Name:JENNELL
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 FORSYTH ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2051
Mailing Address - Country:US
Mailing Address - Phone:478-633-8100
Mailing Address - Fax:478-633-6268
Practice Address - Street 1:1014 FORSYTH ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2051
Practice Address - Country:US
Practice Address - Phone:478-633-8100
Practice Address - Fax:478-633-6268
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-07
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0172362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics