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1043608474 NPI number — CANDLER INTERNAL MEDICINE

NPI Number: 1043608474
Health Care Provider/Practitioner: CANDLER INTERNAL MEDICINE

Information about “1043608474” NPI (CANDLER INTERNAL MEDICINE) exists in 1043608474 in HTML format HTML  |  1043608474 in plain Text format TXT  |  1043608474 in PDF (Portable Document Format) PDF  |  1043608474 in an XML format XML  formats.

NPI Number : 1043608474 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043608474",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "CANDLER INTERNAL MEDICINE",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 2029",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STATESBORO",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30459-2029",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "912-685-3992",
    "MailingAddressFaxNumber": "912-681-1444",
    "FirstLinePracticeLocationAddress": "380 SCONYERS ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "METTER",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30439-3261",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-685-3992",
    "PracticeLocationAddressFaxNumber": "912-681-1444",
    "EnumerationDate": "01/08/2015",
    "LastUpdateDate": "01/22/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "REDDY",
    "AuthorizedOfficialFirstName": "RANI",
    "AuthorizedOfficialMiddleName": "S",
    "AuthorizedOfficialTitle": "M.D.",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "M.D.",
    "AuthorizedOfficialTelephoneNumber": "912-682-1097",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": [
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        },
        {
          "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
          "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
        }
      ]
    }
  }
}
                
            

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