Healthcare Provider Details

I. General information

NPI: 1184589855
Provider Name (Legal Business Name): ALAN MCINTOSH
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 W CHERRY ST
JESUP GA
31545-1435
US

IV. Provider business mailing address

6363 HACKLEBARNEY RD
BLACKSHEAR GA
31516-6034
US

V. Phone/Fax

Practice location:
  • Phone: 912-256-5610
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018134
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: