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General NPI Number Information
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NPI Number | 1326629247
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Entity Type | Individual
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Provider Name | KIARA PHELPS MD
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Gender | Female
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Dates
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Enumeration Date | 04/21/2021
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 4000 SAINT MARYS RD STE A
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City | COLUMBUS
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State | GA
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Zip | 31907-7625
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Country | US
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Telephone | 706-685-2770
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Fax |
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Provider Business Mailing Address
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Address Line | 420 AVENUE F
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City | BOGALUSA
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State | LA
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Zip | 70427-3634
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Country | US
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Telephone | 985-732-0058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 101181
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License Number State | GA
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