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General NPI Number Information
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NPI Number | 1689893653
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Entity Type | Organization
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Legal Business Name | CANDLER INTERNAL MEDICINE
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 05/19/2009
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Provider Practice Location Address
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Address Line | 106 BRIARWOOD RD
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City | STATESBORO
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State | GA
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Zip | 30458-2459
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Country | US
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Telephone | 912-871-5000
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Fax | 912-681-1444
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Provider Business Mailing Address
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Address Line | PO BOX 2029
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City | STATESBORO
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State | GA
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Zip | 30459-2029
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Country | US
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Telephone | 912-871-5000
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Fax | 912-681-1444
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANI S. REDDY
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Credential | MD
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Telephone | 912-871-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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