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BULLOCH FAMILY PRACTICE
NPI 1477239218
Family Medicine in Statesboro, GA

Active since June 26, 2023CLIA 11D2285173 · Waiver
112 HILL POND LN, STATESBORO, GA 30458(912) 259-9633 Get Directions Write a Review

NPPES record last updated: November 20, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Bulloch Family Practice NPPES

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

BULLOCH FAMILY PRACTICE (NPI 1477239218) is a healthcare organization registered as a family medicine in Statesboro, Georgia and active in the NPI registry since June 2023. The organization holds a CLIA Waiver certificate valid through July 6, 2027 and lists Loy D Cowart, Owner, as its authorized official.

NPPES Registry Identity

NPI1477239218
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameBULLOCH FAMILY PRACTICE
Location Address112 HILL POND LNStatesboro, GA 30458-0872
Mailing Address911 Monarch CirStatesboro, GA 30458-9197
Phone(912) 259-9633
Organization SubpartNo
Authorized OfficialLoy D CowartOwner · (912) 259-9633
Enumeration DateJune 26, 2023
Last NPPES UpdateNovember 20, 2023
NPPES CertifiedNovember 20, 2023
✔ NPI 1477239218 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
112 HILL POND LN, 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

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 11D2285173

Bulloch Family Practice LLC · Statesboro, GA
Active · expires Jul 6, 2027
CLIA Number11D2285173
Laboratory TypePhysician Office
Certificate Effective DateJuly 7, 2025
Certificate Expiration DateJuly 6, 2027
Laboratory DirectorLoy D. Cowart III
Laboratory Phone(912) 237-9228
Laboratory LocationBulloch Family Practice LLC112 Hill Pond Lane, Statesboro, GA 30458
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

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

DR. MICHAEL C DEAL M.D.
Pediatrics
112 HILL POND LN
STATESBORO, GA 30458
Bulloch County (912) 489-3325
DEANNA HODNICKI CPNP
Nurse Practitioner (Pediatrics)
112 HILL POND LN
STATESBORO, GA 30458
Bulloch County (912) 489-3325

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 Bulloch Family Practice's NPI number?

The NPI number for Bulloch Family Practice is 1477239218. It was assigned to this organization in the NPPES registry on June 26, 2023.

Where is Bulloch Family Practice located?

Bulloch Family Practice is located at 112 Hill Pond Ln, Statesboro, GA 30458. The listed phone number is (912) 259-9633.

What is Bulloch Family Practice's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Bulloch Family Practice hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D2285173) is associated with this NPI, valid through July 6, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Bulloch Family Practice was last updated on November 20, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.