Healthcare Provider Details

I. General information

NPI: 1568518504
Provider Name (Legal Business Name): CANCER CARE PAVILION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CANDLER RD SUITE 204
SAVANNAH GA
31405-6023
US

IV. Provider business mailing address

225 CANDLER RD SUITE 204
SAVANNAH GA
31405-6023
US

V. Phone/Fax

Practice location:
  • Phone: 912-819-5704
  • Fax: 912-819-5705
Mailing address:
  • Phone: 912-819-5704
  • Fax: 912-819-5705

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: PRESIDENT & CEO
Credential:
Phone: 912-819-6000