Provider Demographics
NPI:1972739803
Name:CANDLER HOSPITAL, INC.
Entity Type:Organization
Organization Name:CANDLER HOSPITAL, INC.
Other - Org Name:CANDLER HOSPITAL PATHOLOGY LAB
Other - Org Type:Other Name
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:912-819-6901
Mailing Address - Street 1:5353 REYNOLDS ST
Mailing Address - Street 2:
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 1:5353 REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-6015
Practice Address - Country:US
Practice Address - Phone:912-819-5290
Practice Address - Fax:912-819-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025-002291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11D0022060OtherCLIA ID NUMBER
GA00000327AMedicaid
GA11D0022060OtherCLIA ID NUMBER