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General NPI Number Information
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NPI Number | 1609997733
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Entity Type | Individual
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Provider Name | THOMAS JOSEPH MCINTYRE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 09/10/2007
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Provider Practice Location Address
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Address Line | 2219 SCENIC DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3131
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Country | US
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Telephone | 770-985-0837
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Fax | 770-985-6677
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Provider Business Mailing Address
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Address Line | 2219 SCENIC DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-3131
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Country | US
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Telephone | 770-985-0837
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Fax | 770-985-6677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 1012
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 403
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License Number State | GA
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