Provider Demographics
NPI:1699747709
Name:MCINTYRE, ASHLEY DARNELL (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:DARNELL
Last Name:MCINTYRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 MITYLENE PARK LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-7302
Mailing Address - Country:US
Mailing Address - Phone:334-279-8180
Mailing Address - Fax:334-279-8214
Practice Address - Street 1:129 MITYLENE PARK LN
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7302
Practice Address - Country:US
Practice Address - Phone:334-279-8180
Practice Address - Fax:334-279-8214
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00025985208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009991115Medicaid
0102102OtherUNITED HEALTHCARE
051528013OtherBLUE CROSS BLUE SHIELD
AL009991115Medicaid
ALK447Medicare PIN