Provider Demographics
NPI:1316092513
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 1:40 OKATIE CENTER BLVD
Mailing Address - Street 2:210
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29909-7507
Mailing Address - Country:US
Mailing Address - Phone:843-705-8925
Mailing Address - Fax:843-682-3905
Practice Address - Street 1:6301 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5701
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:2007-01-25
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC4768Medicare PIN