Healthcare Provider Details

I. General information

NPI: 1336313451
Provider Name (Legal Business Name): SOUTHERN HEART GROUP PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6867 SOUTHPOINT DR N SUITE 111
JACKSONVILLE FL
32216-8043
US

IV. Provider business mailing address

6867 SOUTHPOINT DR N SUITE 111
JACKSONVILLE FL
32216-8043
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-0278
  • Fax: 904-296-0279
Mailing address:
  • Phone: 904-296-0278
  • Fax: 904-296-0279

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE PILCHER
Title or Position: PRESIDENT
Credential: MD
Phone: 904-388-1820