Healthcare Provider Details

I. General information

NPI: 1063483923
Provider Name (Legal Business Name): CHARLES ALBERT CAPE M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 EXETER RD
GERMANTOWN TN
38138-3922
US

IV. Provider business mailing address

1575 LAWTON TRL
GERMANTOWN TN
38138-2829
US

V. Phone/Fax

Practice location:
  • Phone: 901-757-1350
  • Fax: 901-757-3493
Mailing address:
  • Phone: 901-753-8486
  • Fax: 901-753-8487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number0000005328
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: