Healthcare Provider Details

I. General information

NPI: 1114238474
Provider Name (Legal Business Name): NICHOLAS MICHAEL CAPITO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2010
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 J DEWEY GRAY CIR
AUGUSTA GA
30909
US

IV. Provider business mailing address

3650 J DEWEY GRAY CIR
AUGUSTA GA
30909-1867
US

V. Phone/Fax

Practice location:
  • Phone: 706-863-9797
  • Fax: 706-860-7686
Mailing address:
  • Phone: 706-863-9797
  • Fax: 706-860-7686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number40050
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2010021765
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number14886
License Number StateRI
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number076656
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: