Provider Demographics
NPI:1992383426
Name:MCINTIRE, NICHOLAS I
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:I
Last Name:MCINTIRE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 632476
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-2476
Mailing Address - Country:US
Mailing Address - Phone:423-239-7300
Mailing Address - Fax:423-239-7607
Practice Address - Street 1:1242 W SHIPLEY FERRY RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-3323
Practice Address - Country:US
Practice Address - Phone:423-239-7300
Practice Address - Fax:423-239-7607
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71749207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine