Individual
JAYSON B. PHELPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
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
213E00000X
Podiatrist
Primary
POD001006
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10042144
—
GA
01
—
2701740
EVERCARE
GA
05
—
322061
—
GA
01
—
581994261
UNITED HEALTHCARE
GA
01
—
7595720
AETNA
GA
05
—
82974624A
—
GA
05
—
829746724A
—
GA
05
—
829746724B
—
GA
05
—
829746724O
—
GA
Enumeration date
01/30/2006
Last updated
01/02/2019
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