SOUTH GEORGIA PEDIATRICS, P.C.
NPI 1578797627
Specialist in Statesboro, GA

Q: What is South Georgia Pediatrics, P.C.'s NPI number?

The NPI number for South Georgia Pediatrics, P.C. is 1578797627. It was assigned to this organization in the NPPES registry on May 5, 2009.

Q: What is South Georgia Pediatrics, P.C.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Active since May 05, 2009CLIA 11D1099601 · Waiver

1230 BRAMPTON AVE, STATESBORO, GA 30458(912) 489-5437(912) 489-5550 Get Directions Write a Review

NPPES record last updated: May 7, 2009. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About South Georgia Pediatrics, P.c. NPPES

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

SOUTH GEORGIA PEDIATRICS, P.C. (NPI 1578797627) is a healthcare organization registered as a specialist in Statesboro, Georgia and active in the NPI registry since May 2009. The organization holds a CLIA Waiver certificate valid through May 17, 2027 and lists Rao Tulasi Immaneni, Ceo, as its authorized official.

NPPES Registry Identity

NPI1578797627

Entity TypeOrganization

Primary Taxonomy174400000X

Legal Business NameSOUTH GEORGIA PEDIATRICS, P.C.

Location Address1230 BRAMPTON AVEStatesboro, GA 30458-0849

Mailing AddressPo Box 1039Statesboro, GA 30459-1039 · (912) 489-5437 · Fax (912) 489-5550

Phone(912) 489-5437

Fax(912) 489-5550

Organization SubpartNo

Authorized OfficialRao Tulasi ImmaneniCeo · (912) 247-0409

Enumeration DateMay 5, 2009

Last NPPES UpdateMay 7, 2009

✔ NPI 1578797627 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers

Taxonomy Code174400000X

License✔ Licensed in GA · 044756

Definition

An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

Also ListedClinic/CenterTaxonomy 261Q00000X · License APPLIED FOR (GA)

1230 BRAMPTON AVE, Statesboro, GA 30458

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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 11D1099601

South Georgia Pediatrics PC · Statesboro, GA

Active · expires May 17, 2027

CLIA Number11D1099601

Laboratory TypePhysician Office

Certificate Effective DateMay 18, 2025

Certificate Expiration DateMay 17, 2027

Laboratory DirectorRao Immaneni

Laboratory Phone(912) 489-5437

Laboratory LocationSouth Georgia Pediatrics PC1230 Brampton Avenue, Statesboro, GA 30458

CLIA data matches this NPI record on: Address Name Phone

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.

PATRICIA MOORE FNP-BC, APRN

Nurse Practitioner (Family)

1230 BRAMPTON AVE
STATESBORO, GA 30458

Bulloch County (912) 489-5437

RAO PRASAD IMMANENI M.D.

Pediatrics

1230 BRAMPTON AVE
STATESBORO, GA 30458

Bulloch County (912) 489-5437

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 South Georgia Pediatrics, P.C.'s NPI number?

The NPI number for South Georgia Pediatrics, P.C. is 1578797627. It was assigned to this organization in the NPPES registry on May 5, 2009.

Where is South Georgia Pediatrics, P.C. located?

South Georgia Pediatrics, P.C. is located at 1230 Brampton Ave, Statesboro, GA 30458. The listed phone number is (912) 489-5437.

What is South Georgia Pediatrics, P.C.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does South Georgia Pediatrics, P.C. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1099601) is associated with this NPI, valid through May 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does South Georgia Pediatrics, P.C. accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list South Georgia Pediatrics, P.C. 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 South Georgia Pediatrics, P.C. was last updated on May 7, 2009. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.