Healthcare Provider Details

I. General information

NPI: 1043608474
Provider Name (Legal Business Name): CANDLER INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2015
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 SCONYERS ST
METTER GA
30439-3261
US

IV. Provider business mailing address

PO BOX 2029
STATESBORO GA
30459-2029
US

V. Phone/Fax

Practice location:
  • Phone: 912-685-3992
  • Fax: 912-681-1444
Mailing address:
  • Phone: 912-685-3992
  • Fax: 912-681-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateGA

VIII. Authorized Official

Name: RANI S REDDY
Title or Position: M.D.
Credential: M.D.
Phone: 912-682-1097