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PROVIDENCE OBGYN LLC
NPI 1124750369
Obstetrics & Gynecology in Dublin, GA

Active since June 27, 2022CLIA 11D2266575 · Waiver
206 FAIRVIEW PARK DR, DUBLIN, GA 31021(478) 246-4304(478) 246-4282 Get Directions Write a Review

NPPES record last updated: November 17, 2025. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 17, 2025, Aug 3, 2022 (2 updates tracked since 2022).

About Providence Obgyn Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PROVIDENCE OBGYN LLC (NPI 1124750369) is a healthcare organization registered as an obstetrics & gynecology in Dublin, Georgia and active in the NPI registry since June 2022. The organization holds a CLIA Waiver certificate valid through August 11, 2028, maintains a secondary practice location in Dublin, and lists Lauri Bullen, Sole Partner, as its authorized official.

NPPES Registry Identity

NPI1124750369
Entity TypeOrganization
Primary Taxonomy207V00000X
Legal Business NamePROVIDENCE OBGYN LLC
Location Address206 FAIRVIEW PARK DRDublin, GA 31021-2547
Mailing Address206 Fairview Park DrDublin, GA 31021-2547 · (478) 246-4304 · Fax (478) 246-4282
Phone(478) 246-4304
Fax(478) 246-4282
Organization SubpartNo
Authorized OfficialLauri BullenSole Partner · (843) 614-9917
Enumeration DateJune 27, 2022
Last NPPES UpdateNovember 17, 20252 updates tracked since enumeration
NPPES CertifiedNovember 17, 2025
✔ NPI 1124750369 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyObstetrics & GynecologyAllopathic & Osteopathic Physicians
Taxonomy Code207V00000X
Definition
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women.
206 FAIRVIEW PARK DR, Dublin, GA 31021
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Secondary Practice Location 1

Location 1227 Industrial BlvdDublin, GA 31021-2969 · Phone (478) 246-4304 · Fax (478) 246-4282

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Alliant Health Plans, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Providence Obgyn Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Providence Obgyn LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address. They are listed nearest first.

Clinicians, nearest first (3)

Lauri Bullen, MD
Obstetrics/Gynecology
NPI 1760673917
206 FAIRVIEW PARK DR
Dublin, GA 31021
(478) 246-4304
✔ PECOS✔ Accepts MedicareSame address
Juaquasha Hackley
Nurse Practitioner
NPI 1801650668
206 FAIRVIEW PARK DR
Dublin, GA 31021
(478) 246-4304
✔ PECOS✔ Accepts MedicareSame address
Makayla Hardeman, WHNP-BC, CNM
Certified Nurse Midwife (CNM)
NPI 1891426656
3455 PEACHTREE RD NE STE 500
Atlanta, GA 30326
(914) 919-9200
✔ PECOS✔ Accepts Medicare122 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 11D2266575

Providence Ob/Gyn, LLC · Dublin, GA
Active · expires Aug 11, 2028
CLIA Number11D2266575
Laboratory TypePhysician Office
Certificate Effective DateAugust 12, 2026
Certificate Expiration DateAugust 11, 2028
Laboratory DirectorLauri W. Bullen
Laboratory Phone(478) 246-4304
Laboratory LocationProvidence Ob/Gyn, LLC206 Fairview Park Drive, Dublin, GA 31021
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Providence Obgyn LLC's NPI number?

The NPI number for Providence Obgyn LLC is 1124750369. It was assigned to this organization in the NPPES registry on June 27, 2022.

Where is Providence Obgyn LLC located?

Providence Obgyn LLC is located at 206 Fairview Park Dr, Dublin, GA 31021. The listed phone number is (478) 246-4304.

What is Providence Obgyn LLC's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology with taxonomy code 207V00000X.

Is Providence Obgyn LLC enrolled in Medicare?

Yes. Providence Obgyn LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Providence Obgyn LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Providence Obgyn LLC, in Certified Nurse Midwife (CNM), Nurse Practitioner and Obstetrics/Gynecology. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Providence Obgyn LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2266575) is associated with this NPI, valid through August 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Providence Obgyn LLC accept?

Health plans from Alliant Health Plans, Inc. list Providence Obgyn LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Providence Obgyn LLC was last updated on November 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.