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VICTORIA FAMILY PRACTICE CLINIC, LLC
NPI 1700119997
Family Medicine in Statesboro, GA

Active since September 07, 2009CLIA 11D1105867 · Waiver
23 LESTER RD, STATESBORO, GA 30458(912) 225-1836(912) 225-0645 Get Directions Write a Review

NPPES record last updated: January 20, 2012. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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

NPI1700119997
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameVICTORIA FAMILY PRACTICE CLINIC, LLC
Location Address23 LESTER RDStatesboro, GA 30458-4700
Mailing Address23 Lester RdStatesboro, GA 30458-4700 · (912) 225-1836 · Fax (912) 225-0645
Phone(912) 225-1836
Fax(912) 225-0645
Organization SubpartNo
Authorized OfficialOsaretin Daniel OkungbowaOwner · (912) 225-1836
Enumeration DateSeptember 7, 2009
Last NPPES UpdateJanuary 20, 2012
✔ NPI 1700119997 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in GA · 062926
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.
23 LESTER RD, Statesboro, GA 30458
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Other Identifiers 2

Medicaid420313629AGA
Medicare PIN202I080053GA

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 11D1105867

Victoria Family Practice Clinic LLC · Statesboro, GA
Active · expires Nov 9, 2027
CLIA Number11D1105867
Laboratory TypePhysician Office
Certificate Effective DateNovember 10, 2025
Certificate Expiration DateNovember 9, 2027
Laboratory DirectorOsaretin D. Okungbowa
Laboratory Phone(912) 225-1836
Laboratory LocationVictoria Family Practice Clinic LLC23 Lester Rd, 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 5

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

MARK S MCCRACKEN MD PC
Internal Medicine
23 LESTER RD
STATESBORO, GA 30458
Bulloch County (912) 764-7900
EAST GEORGIA MEDICAL ASSOC. P C
Internal Medicine
23 LESTER RD
STATESBORO, GA 30458
Bulloch County (912) 764-7900
JOSEPH C. HAND III, M.D.
Internal Medicine
23 LESTER RD
STATESBORO, GA 30458
Bulloch County (912) 764-7900
STATESBORO GENERAL MEDICAL CLINIC LLC
Clinic/Center (Primary Care)
23 LESTER RD
STATESBORO, GA 30458
Bulloch County (912) 764-7900
DR. OSARETIN DANIEL OKUNGBOWA M.D
Family Medicine
23 LESTER RD
STATESBORO, GA 30458
Bulloch County (912) 225-1836

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 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.

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.

What insurance does Victoria Family Practice Clinic, LLC accept?

Health plans from Ambetter Health, Ambetter from Absolute Total Care, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee list Victoria Family Practice Clinic, 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 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.