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NPI Code Detail

MEDICARE: MR. RANDY KYLE BOTTNER MD

MEDICARE: MR. RANDY KYLE BOTTNER MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RC0000XCardiovascular Disease Physician035381GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780673921
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDY KYLE BOTTNER MD
Provider Business Mailing Address
First Line : 6301 ABERCORN ST
Second Line :
City : SAVANNAH
State : GA
Zip : 31405-5701
Country : US
Telephone Number : 912-352-8700
Fax Number : 912-650-6805
Provider Business Practice Location Address
First Line : 6301 ABERCORN ST
Second Line :
City : SAVANNAH
State : GA
Zip : 31405-5701
Country : US
Telephone Number : 912-352-8700
Fax Number : 912-650-6805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 06/12/2015

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Directions to “ MR. RANDY KYLE BOTTNER MD” Practice Location

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