Provider Demographics
NPI:1942383674
Name:CANDLER HOSPITAL, INC.
Entity Type:Organization
Organization Name:CANDLER HOSPITAL, INC.
Other - Org Name:CANDLER PRESCRIPTION CENTER
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:912-819-6000
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:ATTN: LEGAL SERVICES
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6015
Mailing Address - Country:US
Mailing Address - Phone:912-819-5290
Mailing Address - Fax:912-819-5295
Practice Address - Street 1:5356 REYNOLDS ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6016
Practice Address - Country:US
Practice Address - Phone:912-819-7272
Practice Address - Fax:912-819-7282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0079063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00692876AMedicaid
GAFC 1794317OtherDEA
GAFC 1794317OtherDEA