Healthcare Provider Details

I. General information

NPI: 1871039156
Provider Name (Legal Business Name): MCINTOSH CHIROPRATIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FORT KING GEORGE DR
DARIEN GA
31305
US

IV. Provider business mailing address

PO BOX 2539
DARIEN GA
31305-9026
US

V. Phone/Fax

Practice location:
  • Phone: 912-437-2663
  • Fax: 912-437-4719
Mailing address:
  • Phone: 912-437-2663
  • Fax: 912-437-4719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCHIR008187
License Number StateGA

VIII. Authorized Official

Name: DR. TAJNA E PAYNE
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 912-437-2663