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

Q: 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.

Q: What is Providence Obgyn LLC's specialty?

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

Active since June 27, 2022

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: August 16, 2026.

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

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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 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 ›

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

Expired · Aug 11, 2026

CLIA Number11D2266575

Laboratory TypePhysician Office

Certificate Effective DateAugust 12, 2024

Certificate Expiration DateAugust 11, 2026

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.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. ASHLEY RAYE SPIRES PA-C

Physician Assistant (Surgical)