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MAMA DOC PEDIATRICS, LLC
NPI 1477009181
Pediatrics in Statesboro, GA

Active since September 01, 2016CLIA 11D2094450 · Waiver
400 EAST GRADY STREET, STATESBORO, GA 30458(912) 871-5437(912) 623-2037 Get Directions Write a Review

NPPES record last updated: September 1, 2016. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mama Doc Pediatrics, Llc NPPES

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

MAMA DOC PEDIATRICS, LLC (NPI 1477009181) is a healthcare organization registered as a pediatrics in Statesboro, Georgia and active in the NPI registry since September 2016. The organization holds a CLIA Waiver certificate valid through April 16, 2027 and lists Elizabeth Logan Penn, Physician / President, as its authorized official.

NPPES Registry Identity

NPI1477009181
Entity TypeOrganization
Primary Taxonomy208000000X
Legal Business NameMAMA DOC PEDIATRICS, LLC
Location Address400 EAST GRADY STREETStatesboro, GA 30458
Mailing Address400 East Grady StreetStatesboro, GA 30458 · (912) 871-5437 · Fax (912) 623-2037
Phone(912) 871-5437
Fax(912) 623-2037
Organization SubpartNo
Authorized OfficialElizabeth Logan PennPhysician / President · (912) 871-5437
Enumeration DateSeptember 1, 2016
✔ NPI 1477009181 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians
Taxonomy Code208000000X
License✔ Licensed in GA · 67374
Definition
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development.
400 EAST GRADY STREET, Statesboro, GA 30458
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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 Ambetter from Absolute Total Care, Ambetter Health, Ambetter of Alabama and more.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 11D2094450

Mama Doc Pediatrics · Statesboro, GA
Active · expires Apr 16, 2027
CLIA Number11D2094450
Laboratory TypePhysician Office
Certificate Effective DateApril 17, 2025
Certificate Expiration DateApril 16, 2027
Laboratory DirectorAnna H. Benson
Laboratory Phone(912) 871-5437
Laboratory LocationMama Doc Pediatrics4451 Country Club Road Suite B, Statesboro, GA 30458
CLIA data matches this NPI record on: Name 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 Mama Doc Pediatrics, LLC's NPI number?

The NPI number for Mama Doc Pediatrics, LLC is 1477009181. It was assigned to this organization in the NPPES registry on September 1, 2016.

Where is Mama Doc Pediatrics, LLC located?

Mama Doc Pediatrics, LLC is located at 400 East Grady Street, Statesboro, GA 30458. The listed phone number is (912) 871-5437.

What is Mama Doc Pediatrics, LLC's specialty?

The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.

Does Mama Doc Pediatrics, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2094450) is associated with this NPI, valid through April 16, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Mama Doc Pediatrics, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Mama Doc Pediatrics, 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 Mama Doc Pediatrics, LLC was last updated on September 1, 2016. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years 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.