NPI age
3 years
Enumerated 2022-06-27
● Active Type 2 · Organization
Providence Obgyn Llc
Providence Obgyn Llc is 1 of 1893 obstetrics & gynecology organizations in Georgia.
Primary specialty
Obstetrics & Gynecology
Practice locations
2
1 secondary on file
Status
Active
No deactivations on record
Authorized official
Bullen
Sole Partner
Last NPPES update
2025-11-17
Source: monthly bulk 2026-05
How this organization compares
Across 1893 active obstetrics & gynecology providers in Georgia.
NPI age
3 years
↓ 16 yr below median
Practice locations
2
1 secondary on file
Subspecialties
0
NPI lifetime · 2022 → 2026
2022-06Enumerated in NPPES
2022
2026
Where they practice
Primary practice location
206 Fairview Park Dr
Dublin, GA 310212547
Mailing address
206 Fairview Park Dr
Dublin, GA 310212547
Additional practice locations
1 secondary location on file with NPPES.
Location 2
227 Industrial Blvd
Dublin, GA 310212969
Authorized official
Lauri Bullen, MD
Sole Partner
📞 8436149917
Individual providers at this organization
4 individual providers on file at this primary practice address.
- Nikolay Bangiyev, MD Specialist NPI 1962409219
- Lauri Bullen, MD Obstetrics & Gynecology NPI 1760673917
- Juaquasha Hackley Nurse Practitioner NPI 1801650668
- Ashley Spires, PA-C Physician Assistant NPI 1750536298
Specialties
-
Obstetrics & Gynecology PrimaryAn obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other...
Practice context
Multi-provider organization. 4 individual providers on file at this primary address. Plus 1 secondary practice location.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Verify the organization is in good standing.Cross-check with the state's business registration and any applicable licensing boards.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.