Provider Demographics
NPI:1356450910
Name:SAVANNAH CHILDREN'S HEART CENTER, PC
Entity Type:Organization
Organization Name:SAVANNAH CHILDREN'S HEART CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:DWIGHT
Authorized Official - Last Name:BURCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-350-8085
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:2ND FLOOR GA EAR
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-988-5050
Mailing Address - Fax:912-988-5013
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 512
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-8085
Practice Address - Fax:912-350-3703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300031686AMedicaid
GA300031686AMedicaid