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Organization
BULLOCH PEDIATRICS GROUP, LLC
Active
Organization
BULLOCH PEDIATRICS GROUP, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTEN T HART MHSA (PRACTICE MANAGER)
(912) 871-4847
Entity
Organization
Contact information
Practice address
1497 FAIR RD, SUITE 200, STATESBORO, GA 30458-0822
(912) 871-4847
(912) 871-5562
Mailing address
1497 FAIR RD, SUITE 200, STATESBORO, GA 30458-0822
(912) 871-4847
(912) 871-5562
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
RN104429
GA
Other
Enumeration date
06/18/2012
Last updated
06/18/2012
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