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General NPI Number Information
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NPI Number | 1164829883
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH'S VASCULAR GROUP, LLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 11909 MCAULEY DRIVE SUITE 100 A2
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City | SAVANNAH
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State | GA
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Zip | 31419
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Country | US
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Telephone | 912-954-8331
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Fax | 912-352-9782
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Provider Business Mailing Address
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Address Line | 836 E. 65TH STREET SUITE 22
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City | SAVANNAH
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State | GA
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Zip | 31405
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Country | US
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Telephone | 912-819-7878
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Fax | 912-819-3320
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | PAUL P. HUNCHEY
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Credential |
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Telephone | 912-819-6901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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