Healthcare Provider Details

I. General information

NPI: 1376179960
Provider Name (Legal Business Name): CANDLER MEDICAL ONCOLOGY PRACTICE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUCKWALTER PLACE BLVD STE 120
BLUFFTON SC
29910-5154
US

IV. Provider business mailing address

5400 SUTLIVE ST
SAVANNAH GA
31405-4721
US

V. Phone/Fax

Practice location:
  • Phone: 843-836-7120
  • Fax: 843-815-8014
Mailing address:
  • Phone: 912-354-6187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL P HINCHEY
Title or Position: CEO, PRESIDENT
Credential:
Phone: 912-819-6000