11D1055649 CLIA NUMBER - BULLOCH PEDIATRICS GROUP

Laboratory Demographics

  • CLIA Code: 11D1055649
  • Facility Name: BULLOCH PEDIATRICS GROUP
  • Facility Address: 1044 BERMUDA RUN ROAD
    STATESBORO, GA
    ZIP 30458
  • Facility Phone: 912 871-4847
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. PAUL WHITLOCK III
  • NPI Number: 1720341514
  • Taxonomy: 363LP0200X - Nurse Practitioner

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CLIA Record

Field Name Field Value
CLIA Number 11D1055649
LAB Type Physician Office
Facility Name BULLOCH PEDIATRICS GROUP
Street 1044 BERMUDA RUN ROAD
City STATESBORO
State GA
ZIP 30458
Phone 912 871-4847
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 11/9/2023
Certificate Expiration Date 11/8/2025
Facility Type Physician Office
Lab Director DR. PAUL WHITLOCK III

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This page was last updated on: 9/29/2025