MEDICARE: MS. KWANJULA A PHELPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106E00000X	Assistant Behavior Analyst		GA

General Provider Information

NPI Number	:	1700737624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KWANJULA A PHELPS

Provider Business Mailing Address
First Line	:	1680 ROYALWYN DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-3841
Country	:	US
Telephone Number	:	478-321-5985
Fax Number	:

Provider Business Practice Location Address
First Line	:	1680 ROYALWYN DR
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-3841
Country	:	US
Telephone Number	:	478-321-5985
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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