Provider Demographics
NPI:1427014216
Name:SOUTHERN HEART GROUP, P.A.
Entity Type:Organization
Organization Name:SOUTHERN HEART GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:DILLAHUNT
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:904-396-5996
Mailing Address - Street 1:820 PRUDENTIAL DR
Mailing Address - Street 2:SUITE 615
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8210
Mailing Address - Country:US
Mailing Address - Phone:904-398-0998
Mailing Address - Fax:904-398-8481
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 112
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-396-5996
Practice Address - Fax:904-398-2480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99568Medicare ID - Type Unspecified