Provider Demographics
NPI:1598056988
Name:HOSPITAL AUTHORITY OF CANDLER COUNTY
Entity Type:Organization
Organization Name:HOSPITAL AUTHORITY OF CANDLER COUNTY
Other - Org Name:CANDLER SURGICAL AND FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FACHE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-685-5741
Mailing Address - Street 1:PO BOX 597
Mailing Address - Street 2:
Mailing Address - City:METTER
Mailing Address - State:GA
Mailing Address - Zip Code:30439-0597
Mailing Address - Country:US
Mailing Address - Phone:912-826-4057
Mailing Address - Fax:
Practice Address - Street 1:415 CEDAR ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3339
Practice Address - Country:US
Practice Address - Phone:912-685-1251
Practice Address - Fax:912-685-1254
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOSPITAL AUTHORITY OF CANDLER COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-20
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty