Bulloch Pediatrics Group, LLC

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN104429 Issued in GA

Legal business name

BULLOCH PEDIATRICS GROUP, LLC

Practice address

1497 Fair Rd
Suite 200
Statesboro, GA 30458-0822

Phone

(912) 871-4847

Fax

(912) 871-5562

NPI assigned

Jun 18, 2012

Organization subpart

No

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

Authorized official

Name

Mrs. Kristen T Hart, MHSA

Title

Practice Manager

Phone

(912) 871-4847

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1720341514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "SUITE 200",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580822",
            "telephone_number": "912-871-4847",
            "fax_number": "912-871-5562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1497 FAIR RD",
            "address_2": "SUITE 200",
            "city": "STATESBORO",
            "state": "GA",
            "postal_code": "304580822",
            "telephone_number": "912-871-4847",
            "fax_number": "912-871-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BULLOCH PEDIATRICS GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-18",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "HART",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "912-871-4847",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MHSA"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "GA",
            "license": "RN104429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Bulloch Recovery Resources
• Burke Hospital Company
• Burke Hospital Company
• Merrill Nelson Burke, APRN

• Pediatric Nurse Practitioner in Statesboro, GA
• Providers in Statesboro, GA by specialty
• Pediatric Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.