Provider Demographics
NPI:1811256746
Name:MCINTYRE, PAULINE JAMES (OTR)
Entity type:Individual
Prefix:MRS
First Name:PAULINE
Middle Name:JAMES
Last Name:MCINTYRE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2668 TIFT WAY NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6003
Mailing Address - Country:US
Mailing Address - Phone:678-414-9928
Mailing Address - Fax:678-290-3390
Practice Address - Street 1:2668 TIFT WAY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6003
Practice Address - Country:US
Practice Address - Phone:678-414-9928
Practice Address - Fax:678-290-3390
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-13
Last Update Date:2012-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT002428172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker