Healthcare Provider Details

I. General information

NPI: 1699752303
Provider Name (Legal Business Name): JONAH M MCINTYRE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 MEDICAL PARK DR
ATMORE AL
36502-3016
US

IV. Provider business mailing address

PO BOX 70211
MOBILE AL
36670-1211
US

V. Phone/Fax

Practice location:
  • Phone: 251-368-2550
  • Fax: 251-476-5460
Mailing address:
  • Phone: 251-368-2550
  • Fax: 251-476-5460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number24551
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: