Providence OBGYN LLC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

PROVIDENCE OBGYN LLC

Practice address

206 Fairview Park Dr
Dublin, GA 31021-2547

Phone

(478) 246-4304

Fax

(478) 246-4282

NPI assigned

Jun 27, 2022

Last updated

Nov 17, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lauri Bullen, MDNPI 1760673917

Title

Sole Partner

Phone

(843) 614-9917

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lauri Wilkes Bullen, MD

  • Obstetrics & Gynecology Physician
  • Dublin, GA
  • NPI 1760673917
  Medicare reassignment Care Compare group NPD Authorized official
• Juaquasha Hackley

  • Women's Health Nurse Practitioner
  • Dublin, GA
  • NPI 1801650668
  Medicare reassignment Care Compare group NPD
• Ashley Raye Spires, PA-C

  • Surgical Physician Assistant
  • Dublin, GA
  • NPI 1750536298
  Medicare reassignment Care Compare group NPD
• Makayla Nicole Hardeman, WHNP-BC, CNM

  • Advanced Practice Midwife
  • Atlanta, GA
  • NPI 1891426656
  Medicare reassignment Care Compare group
• Nikolay Bangiyev, MD

  • Specialist
  • Dublin, GA
  • NPI 1962409219
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1763337600000",
    "number": "1124750369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212547",
            "telephone_number": "478-246-4304",
            "fax_number": "478-246-4282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 FAIRVIEW PARK DR",
            "city": "DUBLIN",
            "state": "GA",
            "postal_code": "310212547",
            "telephone_number": "478-246-4304",
            "fax_number": "478-246-4282"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 Industrial Blvd",
            "address_purpose": "LOCATION",
            "city": "Dublin",
            "state": "GA",
            "postal_code": "310212969",
            "country_code": "US",
            "telephone_number": "478-246-4304",
            "fax_number": "478-246-4282",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE OBGYN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-27",
        "last_updated": "2025-11-17",
        "certification_date": "2025-11-17",
        "status": "A",
        "authorized_official_last_name": "BULLEN",
        "authorized_official_first_name": "LAURI",
        "authorized_official_title_or_position": "SOLE PARTNER",
        "authorized_official_telephone_number": "843-614-9917",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premier Estates of Dublin LLC
• Amber Price, NP
• Breanna Price, M.ED., CCC-SLP
• James W Price, M.D.
• Toni Price, LMSW
• Jaydon Allen Pryor
• Sharon D Pryor, LMSW
• Purposed Investments LLC (TIG Transportation Service)
• Jacquelyn S Purser, RN
• John Alan Purser, RPH

• Obstetrics & Gynecology Physician in Dublin, GA
• Providers in Dublin, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.