Provider Demographics
NPI:1083607113
Name:CAPUT, WIILIAM G (MD)
Entity Type:Individual
Prefix:
First Name:WIILIAM
Middle Name:G
Last Name:CAPUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:GA
Mailing Address - Zip Code:30828-0312
Mailing Address - Country:US
Mailing Address - Phone:706-465-3253
Mailing Address - Fax:706-465-3256
Practice Address - Street 1:1008 ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:GA
Practice Address - Zip Code:30828-9109
Practice Address - Country:US
Practice Address - Phone:706-465-3253
Practice Address - Fax:706-465-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA024658207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
680733OtherGA STATE HEALTH #
680733OtherGA STATE HEALTH #
D45006Medicare UPIN