Healthcare Provider Details

I. General information

NPI: 1124758966
Provider Name (Legal Business Name): SJC GENERAL SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1326 EISENHOWER DRIVE BLDG 2
SAVANNAH GA
31406-3928
US

IV. Provider business mailing address

838 EAST 65TH STREET SUITE 22
SAVANNAH GA
31405-4493
US

V. Phone/Fax

Practice location:
  • Phone: 912-354-6303
  • Fax: 912-355-8655
Mailing address:
  • Phone: 912-819-2622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL P. HINCHEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 912-819-6901