Healthcare Provider Details

I. General information

NPI: 1770509333
Provider Name (Legal Business Name): CANDLER MEDICAL GROUP INC - MERCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MALL BOULEVARD SUITE E
SAVANNAH GA
31408-4869
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 912-352-7194
  • Fax: 912-352-3131
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
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL P HINCHEY
Title or Position: PRESIDENT/ CEO
Credential:
Phone: 912-819-6101