Healthcare Provider Details

I. General information

NPI: 1346354925
Provider Name (Legal Business Name): JEANNE MARTINEZ MCINTYRE CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 MIDDLE RD S
LEESBURG GA
31763-3436
US

IV. Provider business mailing address

740 MIDDLE RD S
LEESBURG GA
31763-3436
US

V. Phone/Fax

Practice location:
  • Phone: 229-878-5019
  • Fax:
Mailing address:
  • Phone: 229-878-5019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number168577
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: