1770509333 NPI number — CANDLER MEDICAL GROUP INC - MERCY

Table of content: (NPI 1770509333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770509333 NPI number — CANDLER MEDICAL GROUP INC - MERCY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANDLER MEDICAL GROUP INC - MERCY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SJC MEDICAL GROUP INC- SOUTHSIDE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770509333
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
602 E. 72ND STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-4913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-819-7878
Provider Business Mailing Address Fax Number:
912-819-5044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 MALL BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31408-4869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-352-7194
Provider Business Practice Location Address Fax Number:
912-352-3131
Provider Enumeration Date:
07/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HINCHEY
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
912-819-6101

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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