Dominique Jacqueline McIntosh, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN195908 Issued in GA

Practice address

3720 Holcomb Bridge Rd
Peachtree Corners, GA 30092-4795

Phone

(770) 263-1000

NPI assigned

Jul 31, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dominique Jacqueline McIntosh Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peachtree Immediate Care FP, LLC

  • Family Medicine Physician
  • Hiram, GA
  • NPI 1437194156
  Medicare reassignment NPD
• Community Care Health Network LLC

  • Nurse Practitioner
  • Nashville, TN
  • NPI 1619368842

  GA

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1501459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501459200000",
    "number": "1689198798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6829 DANFORTH WAY",
            "city": "STONE MOUNTAIN",
            "state": "GA",
            "postal_code": "300876370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3720 HOLCOMB BRIDGE RD",
            "city": "PEACHTREE CORNERS",
            "state": "GA",
            "postal_code": "300924795",
            "telephone_number": "770-263-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINTOSH",
        "first_name": "DOMINIQUE",
        "middle_name": "JACQUELINE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-07-31",
        "last_updated": "2017-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN195908",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "MCINTOSH",
            "middle_name": "JACQUELINE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kiera McDaniel, BA
• Haley McDonald, PT, DPT
• Annie McFadden, THERAPIST
• Tracy Dishon McGarvey, RN,ADMINISTRATOR
• Akemi-Joi McGoogan, LCSW
• Megan Tayler McPherson
• Christine Marie Mederos, MS, CCC-SLP
• Emmanuela Medrea, RPH
• Medstop , LLC
• Joshua Meeks, PHARMD

• Family Nurse Practitioner in Peachtree Corners, GA
• Providers in Peachtree Corners, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.