Organization
LOGANVILLE FOOT AND ANKLE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAYSON PHELPS DPM (PODIATRST)
(678) 639-4209
Entity
Organization
Contact information
Practice address
3529 HIGHWAY 81, LOGANVILLE, GA 30052-4336
(678) 639-4209
(678) 639-4210
Mailing address
3529 HIGHWAY 81 S, LOGANVILLE, GA 30052-0043
(678) 639-4209
(678) 639-4210
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD001006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
829746724O
—
GA
Enumeration date
08/28/2015
Last updated
08/28/2015
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