Healthcare Provider Details

I. General information

NPI: 1043519838
Provider Name (Legal Business Name): HOLLY MCINTIRE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2011
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3512 OLD MONTGOMERY HWY
BIRMINGHAM AL
35209-5706
US

IV. Provider business mailing address

1010 AIRPARK CENTER DR
NASHVILLE TN
37217-5200
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2260
  • Fax: 205-879-2261
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number21032
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number31488
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number21032
License Number StateMS
# 4
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number31488
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: