Loganville Foot and Ankle

Primary specialty

PodiatristTaxonomy code 213E00000X

License

POD001006 Issued in GA

Legal business name

LOGANVILLE FOOT AND ANKLE

Practice address

3529 Highway 81
Loganville, GA 30052-4336

Phone

(678) 639-4209

Fax

(678) 639-4210

NPI assigned

Aug 28, 2015

Last updated

Aug 28, 2015By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jayson Phelps, DPMNPI 1851362644

Title

Podiatrst

Phone

(678) 639-4209

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jayson B. Phelps, DPM

  • Podiatrist
  • Loganville, GA
  • NPI 1851362644
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1440720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440720000000",
    "number": "1285001933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3529 HIGHWAY 81 S",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300520043",
            "telephone_number": "678-639-4209",
            "fax_number": "678-639-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3529 HIGHWAY 81",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300524336",
            "telephone_number": "678-639-4209",
            "fax_number": "678-639-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOGANVILLE FOOT AND ANKLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-28",
        "last_updated": "2015-08-28",
        "status": "A",
        "authorized_official_last_name": "PHELPS",
        "authorized_official_first_name": "JAYSON",
        "authorized_official_title_or_position": "PODIATRST",
        "authorized_official_telephone_number": "678-639-4209",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "GA",
            "license": "POD001006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "829746724O",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Loganville Community Ministry Village, Inc.
• Loganville Dental Associates
• Loganville Dentist Office, PC (Loganville Dentist Office)
• Loganville Eyecare, PC
• Loganville Family Dentistry
• Loganville Foot and Ankle Medicine LLC
• Loganville Pediatrics & Adolescent Care Associates
• Dorian Grace Longshore, DMD
• Chrissy Leach Lort, MSW
• Saniya Love

• Podiatrist in Loganville, GA
• Providers in Loganville, GA by specialty
• Podiatrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.