Provider Demographics
NPI:1407020787
Name:SAVANNAH CARDIOLOGY, PC
Entity Type:Organization
Organization Name:SAVANNAH CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BOTTNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-352-8700
Mailing Address - Street 1:6301 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5701
Mailing Address - Country:US
Mailing Address - Phone:912-352-8700
Mailing Address - Fax:912-650-6805
Practice Address - Street 1:459 HIGHWAY 119 S
Practice Address - Street 2:PHYSICIAN CENTER OFFICE
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329
Practice Address - Country:US
Practice Address - Phone:912-352-8700
Practice Address - Fax:912-650-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP170Medicare PIN