Basic Information
| Provider Information | |||||||||
| NPI: | 1487276010 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCINTOSH | ||||||||
| FirstName: | DIXIE | ||||||||
| MiddleName: | LORAINE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 925 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309030925 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067248611 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1348 WALTON WAY STE 5100 | ||||||||
| Address2: | |||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 309015108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067248611 | ||||||||
| FaxNumber: | 7067246202 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2020 | ||||||||
| LastUpdateDate: | 06/15/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 150973 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.