BULLOCH PEDIATRICS, PC
NPI 1679775712
Pediatrics in Statesboro, GA

Q: What is Bulloch Pediatrics, PC's NPI number?

The NPI number for Bulloch Pediatrics, PC is 1679775712. It was assigned to this organization in the NPPES registry on June 1, 2007.

Q: What is Bulloch Pediatrics, PC's specialty?

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

Active since June 01, 2007CLIA 11D1055649 · Waiver

1497 FAIR RD, STE 200, STATESBORO, GA 30458(912) 871-4847(912) 871-5562 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Bulloch Pediatrics, Pc NPPES

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

BULLOCH PEDIATRICS, PC (NPI 1679775712) is a healthcare organization registered as a pediatrics in Statesboro, Georgia and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through November 8, 2027 and lists Melody K Lightsey, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1679775712

Entity TypeOrganization

Primary Taxonomy208000000X

Legal Business NameBULLOCH PEDIATRICS, PC

Location Address1497 FAIR RD, STE 200Statesboro, GA 30458-0822

Mailing Address1497 Fair Rd, Ste 200Statesboro, GA 30458-0822 · (912) 871-4847 · Fax (912) 871-5562

Phone(912) 871-4847

Fax(912) 871-5562

Organization SubpartNo

Authorized OfficialMelody K LightseyOffice Manager · (912) 871-4847

Enumeration DateJune 1, 2007

Last NPPES UpdateAugust 22, 2020

✔ NPI 1679775712 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPediatricsAllopathic & Osteopathic Physicians

Taxonomy Code208000000X

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.

1497 FAIR RD, 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 11D1055649

Bulloch Pediatrics Group · Statesboro, GA

Active · expires Nov 8, 2027

CLIA Number11D1055649

Laboratory TypePhysician Office

Certificate Effective DateNovember 9, 2025

Certificate Expiration DateNovember 8, 2027

Laboratory DirectorDr. Paul Whitlock III

Laboratory Phone(912) 871-4847

Laboratory LocationBulloch Pediatrics Group1044 Bermuda Run Road, Statesboro, GA 30458

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 19

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

IAN C MUNGER DO

Emergency Medicine

1497 FAIR RD
STATESBORO, GA 30458

Bulloch County (912) 486-1111

CESAR CLINIC, LLC

Specialist

1497 FAIR RD, SUITE 201
STATESBORO, GA 30458

Bulloch County (912) 871-8500

OGEECHEE OB-GYN, P.C.

Obstetrics & Gynecology

1497 FAIR RD, SUITE 300
STATESBORO, GA 30458

Bulloch County (912) 871-6206

EAST GEORGIA REGIONAL MEDICAL CENTER, LLC

Pediatrics

1497 FAIR RD, SUITE 206
STATESBORO, GA 30458

Bulloch County (912) 871-5437

DR. AJAY JAIN MD

Internal Medicine (Cardiovascular Disease)

1497 FAIR RD, SUITE 305
STATESBORO, GA 30458

Bulloch County (912) 681-2273

MR. CLARE D HEIDLER IV CRNA

Nurse Anesthetist, Certified Registered

1497 FAIR RD, SUITE 102
STATESBORO, GA 30458

Bulloch County (912) 486-1973

OGEECHEE OB-GYN, P.C.

Nurse Practitioner (Obstetrics & Gynecology)

1497 FAIR RD, SUITE 300
STATESBORO, GA 30458

Bulloch County (912) 871-6206

JOHN EDWARD MARTIN SR. MD

Surgery

1497 FAIR RD, SUITE 103
STATESBORO, GA 30458

Bulloch County (912) 486-1163

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 Pediatrics, PC's NPI number?

The NPI number for Bulloch Pediatrics, PC is 1679775712. It was assigned to this organization in the NPPES registry on June 1, 2007.

Where is Bulloch Pediatrics, PC located?

Bulloch Pediatrics, PC is located at 1497 Fair Rd Ste 200, Statesboro, GA 30458. The listed phone number is (912) 871-4847.

What is Bulloch Pediatrics, PC's specialty?

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

Does Bulloch Pediatrics, PC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 11D1055649) is associated with this NPI, valid through November 8, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Bulloch Pediatrics, PC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Bulloch Pediatrics, PC 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 Bulloch Pediatrics, PC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.