Provider Demographics
NPI:1245619592
Name:ERTLE, VALERIE CAPUY (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:CAPUY
Last Name:ERTLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:VALERIE
Other - Middle Name:ANN
Other - Last Name:CAPUY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2467 GOLDEN CAMP RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30906-5515
Mailing Address - Country:US
Mailing Address - Phone:706-790-4440
Mailing Address - Fax:706-790-4393
Practice Address - Street 1:1111 GARREDD BLVD STE A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6751
Practice Address - Country:US
Practice Address - Phone:706-863-6674
Practice Address - Fax:706-868-7057
Is Sole Proprietor?:No
Enumeration Date:2015-05-20
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83314208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program