Individual
MRS. STEPHANIE MCINTOSH JUNIOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
107 WEDGEWOOD DR, CARROLLTON, GA 30117-4335
(678) 390-7070
(678) 390-7071
Mailing address
106 WATSON DR, BREMEN, GA 30110-1794
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN233377
GA
363LP0200X
Pediatric Nurse Practitioner
Primary
RN233377
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1861915647
GROUP NPI
GA
Enumeration date
10/10/2019
Last updated
03/25/2025
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