Provider Demographics
NPI:1730690561
Name:ST. JOSEPH'S/CANDLER OB/GYN PRACTICE, LLC
Entity type:Organization
Organization Name:ST. JOSEPH'S/CANDLER OB/GYN PRACTICE, LLC
Other - Org Name:
Other - Org Type:
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 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:912-819-7171
Mailing Address - Fax:912-691-9287
Practice Address - Street 1:5353 REYNOLDS STREET
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4913
Practice Address - Country:US
Practice Address - Phone:912-819-7800
Practice Address - Fax:912-819-7850
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH'S/CANDLER OB/GYN PRACTICE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-10-19
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA17095534OtherCONTROL NUMBER