Healthcare Provider Details

I. General information

NPI: 1871394841
Provider Name (Legal Business Name): CAPRI MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9280 HIGHWAY 5 STE A
DOUGLASVILLE GA
30134-1501
US

IV. Provider business mailing address

9280 HIGHWAY 5 STE A
DOUGLASVILLE GA
30134-1501
US

V. Phone/Fax

Practice location:
  • Phone: 770-726-8988
  • Fax: 470-689-3325
Mailing address:
  • Phone: 770-726-8988
  • Fax: 470-689-3325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLIE ROUSE
Title or Position: CO-PRESIDENT
Credential: MD
Phone: 678-621-4715