Individual provider Active NPI

Bethrand Okafor Ugwu, PA-C

  • Physician Assistant
  • Statesboro, GA
National Provider Identifier
1437021649
Registry record updated Dec 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
13543 Issued in GA
Practice address
1030 Bermuda Run
Statesboro, GA 30458-0858
Phone
(912) 764-8396
Fax
(912) 764-7188
NPI assigned
Sep 18, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 13543 GA Primary

Addresses

Primary practice location

1030 Bermuda Run
Statesboro, GA 30458-0858

Mailing address

1030 Bermuda Run
Statesboro, GA 30458-0858
Phone (912) 764-8396

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260617002417 GA Practitioner - Physician Assistant 7911479258 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

105 Highpoint Rd
Statesboro, GA 30458-8631

129 Bull Bay Dr
Statesboro, GA 30458-7275

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
13543GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Atekha Nephrology Clinic CurrentSince Sep 21, 2025 Accepting new patients

Locations

1030 Bermuda Run
Statesboro, GA 30458
Phone (912) 764-8396

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1758153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765929600000",
    "number": "1437021649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 BERMUDA RUN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580858",
            "telephone_number": "912-764-8396",
            "fax_number": "912-764-7188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 BERMUDA RUN",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580858",
            "telephone_number": "912-764-8396",
            "fax_number": "912-764-7188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UGWU",
        "first_name": "BETHRAND",
        "middle_name": "OKAFOR",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-09-18",
        "last_updated": "2025-12-17",
        "certification_date": "2025-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "13543",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Statesboro, GA

Sources for this page

Verify at the official NPI Registry.