Provider Demographics
NPI:1871743617
Name:ST.JOSEPH'S/CANDLER HOSPITAL
Entity type:Organization
Organization Name:ST.JOSEPH'S/CANDLER HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MSN, APRN,BC-ANP
Authorized Official - Prefix:
Authorized Official - First Name:DORA
Authorized Official - Middle Name:AGYEI
Authorized Official - Last Name:AGYEMANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-927-9598
Mailing Address - Street 1:106 QUEENS RETREAT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1652
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
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:912-819-6260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN158183 NP261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care