Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 024060 | GA |
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 24060 | GA |
NPI | 1073582789 |
---|---|
Provider Name | Dr. Angus P Phelts III |
First Address | Columbus, GA 31908-7546 |
Second Address | Columbus, GA 31904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 31/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000415863A | (05) | GA |
E51174 | (02) | GA |