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Organization
LOGANVILLE FOOT AND ANKLE MEDICINE LLC
Active
Organization
LOGANVILLE FOOT AND ANKLE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAYSON B PHELPS DPM (PHYSICIAN/OWNER)
(678) 639-4209
Entity
Organization
Contact information
Practice address
135 LEE BYRD RD, LOGANVILLE, GA 30052-2310
(678) 639-4209
(678) 639-4210
Mailing address
135 LEE BYRD RD, LOGANVILLE, GA 30052-2310
(678) 639-4209
(678) 639-4210
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
POD001006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
581994261
UNITED HEALTHCARE
GA
01
—
7595720
AETNA
GA
05
—
829746724O
—
GA
Enumeration date
05/20/2008
Last updated
10/15/2024
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