Basic Information
| Provider Information | |||||||||
| NPI: | 1124758966 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SJC GENERAL SURGERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 838 EAST 65TH STREET | ||||||||
| Address2: | SUITE 22 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314054493 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128192622 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1326 EISENHOWER DRIVE | ||||||||
| Address2: | BLDG 2 | ||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314063928 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123546303 | ||||||||
| FaxNumber: | 9123558655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2022 | ||||||||
| LastUpdateDate: | 06/14/2022 | ||||||||
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| AuthorizedOfficialLastName: | HINCHEY | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | P. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9128196901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CEO | ||||||||
| NPICertificationDate: | 06/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.