MEDICARE: JAYSON B. PHELPS DPM

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	213E00000X	Podiatrist	POD001006	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	581994261	OTHER	GA	UNITED HEALTHCARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7595720	OTHER	GA	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	2701740	OTHER	GA	EVERCARE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851362644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAYSON B. PHELPS DPM

Provider Business Mailing Address
First Line	:	135 LEE BYRD RD
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-2310
Country	:	US
Telephone Number	:	678-639-4209
Fax Number	:	678-639-4210

Provider Business Practice Location Address
First Line	:	135 LEE BYRD RD
Second Line	:
City	:	LOGANVILLE
State	:	GA
Zip	:	30052-2310
Country	:	US
Telephone Number	:	678-639-4209
Fax Number	:	678-639-4210

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	01/02/2019

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Directions to “ JAYSON B. PHELPS DPM” Practice Location

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