Healthcare Provider Details

I. General information

NPI: 1194741850
Provider Name (Legal Business Name): CANDLER MEDICAL GROUP INC - GLENNVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 GRAND CENTRAL BLVD SUITE 107
POOLER GA
31322-4061
US

IV. Provider business mailing address

602 E. 72ND STREET
SAVANNAH GA
31405-4913
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-1999
  • Fax: 912-748-3847
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-5044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL P HINCHEY
Title or Position: PRESIDENT/CEO
Credential:
Phone: 912-819-6901