Provider Demographics
NPI:1326629247
Name:PHELPS, KIARA (MD)
Entity type:Individual
Prefix:DR
First Name:KIARA
Middle Name:
Last Name:PHELPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 AVENUE F
Mailing Address - Street 2:
Mailing Address - City:BOGALUSA
Mailing Address - State:LA
Mailing Address - Zip Code:70427-3634
Mailing Address - Country:US
Mailing Address - Phone:985-732-0058
Mailing Address - Fax:
Practice Address - Street 1:4000 SAINT MARYS RD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31907-7625
Practice Address - Country:US
Practice Address - Phone:706-685-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-21
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA101181207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine