Provider Demographics
NPI:1770509333
Name:CANDLER MEDICAL GROUP INC - MERCY
Entity Type:Organization
Organization Name:CANDLER MEDICAL GROUP INC - MERCY
Other - Org Name:SJC MEDICAL GROUP INC- SOUTHSIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:P
Authorized Official - Last Name:HINCHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-819-6101
Mailing Address - Street 1:602 E. 72ND STREET
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-5044
Practice Address - Street 1:410 MALL BOULEVARD
Practice Address - Street 2:SUITE E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31408-4869
Practice Address - Country:US
Practice Address - Phone:912-352-7194
Practice Address - Fax:912-352-3131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANDLER MEDICAL GROUP INC - MERCY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-15
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4255Medicare UPIN