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BULLOCH PEDIATRICS GROUP LLC NPI 1720341514


NPI Information

NPI: 1720341514
Provider Name: BULLOCH PEDIATRICS GROUP, LLC
Classification: Nurse Practitioner - 363LP0200X
Entity Type: Organization

Specialization: Pediatrics

CLIA Number: 11D1055649

Address:
1497 FAIR RD
SUITE 200
STATESBORO, GA
ZIP 30458
Phone: (912) 871-4847
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BULLOCH PEDIATRICS GROUP, LLC is a pediatrics nurse practitioner in Statesboro, GA. BULLOCH PEDIATRICS GROUP, LLC NPI is 1720341514. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

1497 FAIR RD
SUITE 200
STATESBORO, GA
ZIP 30458-822
Phone: (912) 871-4847
Fax: (912) 871-5562

The provider's authorized official is Kristen T Hart .
The authorized official title is Practice Manager and has the following contact phone number (912) 871-4847.

The CLIA number assigned to this NPI record is 11D1055649 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2012 and was last updated on 6/18/2012.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsRN104429GEORGIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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