Provider Demographics
NPI:1598830994
Name:CAPITO, JENNIFER MILLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MILLER
Last Name:CAPITO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:GALE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1524
Mailing Address - Country:US
Mailing Address - Phone:706-774-7022
Mailing Address - Fax:706-774-7023
Practice Address - Street 1:1348 WALTON WAY STE 5700
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5110
Practice Address - Country:US
Practice Address - Phone:706-774-7022
Practice Address - Fax:706-774-7023
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1346363A00000X
GA004407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant