Organization
PAUL R. PHELPS, SR, M.D., PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY J BRICKLE (BILLING AGENT)
(478) 254-5943
Entity
Organization
Contact information
Practice address
818 FORSYTH STREET, MACON, GA 31201-2139
(478) 633-7010
(478) 633-7585
Mailing address
P.O. BOX 28170, MACON, GA 31221-8170
(478) 254-5943
(478) 254-6093
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
011990
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00071398A
—
GA
01
—
011990
STATE LICENSE
GA
Enumeration date
04/23/2010
Last updated
12/20/2010
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