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General NPI Number Information
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NPI Number | 1457506578
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Entity Type | Organization
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Legal Business Name | CHARLES ANTHONY GAPUTIS
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Dates
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Enumeration Date | 11/18/2008
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Last Update Date | 11/18/2008
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Provider Practice Location Address
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Address Line | 16053 HIGHWAY 72
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City | ROGERSVILLE
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State | AL
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Zip | 35652-8141
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Country | US
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Telephone | 256-247-0093
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Fax | 256-247-7018
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Provider Business Mailing Address
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Address Line | PO BOX 401
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City | ROGERSVILLE
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State | AL
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Zip | 35652-0401
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Country | US
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Telephone | 256-247-0093
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Fax | 256-247-7018
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Authorized Official
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Title or Position | INSURANCE MANAGER
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Name | MS. LAURA B THACKER
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Credential |
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Telephone | 256-247-0093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO192
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License Number State | AL
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