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General NPI Number Information
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NPI Number | 1871039156
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Entity Type | Organization
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Legal Business Name | MCINTOSH CHIROPRATIC
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Dates
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Enumeration Date | 01/11/2017
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 208 FORT KING GEORGE DR
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City | DARIEN
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State | GA
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Zip | 31305
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Country | US
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Telephone | 912-437-2663
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Fax | 912-437-4719
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Provider Business Mailing Address
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Address Line | PO BOX 2539
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City | DARIEN
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State | GA
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Zip | 31305-9026
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Country | US
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Telephone | 912-437-2663
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Fax | 912-437-4719
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. TAJNA E PAYNE
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Credential | D.C.
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Telephone | 912-437-2663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NI0013X
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Taxonomy Name | Independent Medical Examiner Chiropractor
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License Number | CHIR008187
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License Number State | GA
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