Provider Demographics
NPI:1194735357
Name:MCINTOSH, WILLIAM J (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1439 MCLENDON DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1851
Mailing Address - Country:US
Mailing Address - Phone:770-493-9777
Mailing Address - Fax:
Practice Address - Street 1:1439 MCLENDON DR
Practice Address - Street 2:SUITE D
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1851
Practice Address - Country:US
Practice Address - Phone:770-493-9777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY00316103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBFZQMedicare PIN
GA68BBDGXMedicare PIN