Healthcare Provider Details

I. General information

NPI: 1144526542
Provider Name (Legal Business Name): LUTHER WAYNE CAPOOTH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1862 BROOKSEDGE DR
GERMANTOWN TN
38138-2716
US

IV. Provider business mailing address

1862 BROOKSEDGE DR
GERMANTOWN TN
38138-2716
US

V. Phone/Fax

Practice location:
  • Phone: 901-756-6510
  • Fax:
Mailing address:
  • Phone: 901-756-6510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberMD0000007608
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: