VICTORIA FAMILY PRACTICE CLINIC, LLC
NPI 1700119997
Family Medicine in Statesboro, GA
About Victoria Family Practice Clinic, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
VICTORIA FAMILY PRACTICE CLINIC, LLC (NPI 1700119997) is a healthcare organization registered as a family medicine in Statesboro, Georgia and active in the NPI registry since September 2009. The organization holds a CLIA Waiver certificate valid through November 9, 2027 and lists Osaretin Daniel Okungbowa, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 2
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Victoria Family Practice Clinic, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Victoria Family Practice Clinic, LLC, which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 11D1105867
Victoria Family Practice Clinic LLC · Statesboro, GAFrequently 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 Victoria Family Practice Clinic, LLC's NPI number?
The NPI number for Victoria Family Practice Clinic, LLC is 1700119997. It was assigned to this organization in the NPPES registry on September 7, 2009.
Where is Victoria Family Practice Clinic, LLC located?
Victoria Family Practice Clinic, LLC is located at 23 Lester Rd, Statesboro, GA 30458. The listed phone number is (912) 225-1836.
What is Victoria Family Practice Clinic, LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Victoria Family Practice Clinic, LLC enrolled in Medicare?
Yes. Victoria Family Practice Clinic, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Victoria Family Practice Clinic, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Family Practice, reassign their Medicare billing to Victoria Family Practice Clinic, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Victoria Family Practice Clinic, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 11D1105867) is associated with this NPI, valid through November 9, 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 Victoria Family Practice Clinic, LLC was last updated on January 20, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.
# Victoria Family Practice Clinic, Llc · NPI 1700119997
Family Medicine organization in Statesboro, Georgia. Organization record, active in the CMS NPPES registry since September 7, 2009.
## Identity
- **NPI:** 1700119997 (Entity type: Organization)
- **Enumerated:** September 7, 2009
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Osaretin Okungbowa, OWNER
## Practice location
- **Address:** 23 LESTER RD, Statesboro, GA 30458-4700
- **Phone:** (912) 225-1836 · **Fax:** (912) 225-0645
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Family Practice) reassign Medicare billing to this organization (form CMS-855R); 2 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 20, 2012
- **Other identifiers:** Medicaid 420313629A (GA); Medicare PIN 202I080053 (GA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1700119997) · Data from the CMS NPPES public registry.