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General NPI Number Information
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NPI Number | 1871394841
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Entity Type | Organization
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Legal Business Name | CAPRI MEDICAL CENTER
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 9280 HIGHWAY 5 STE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1501
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Country | US
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Telephone | 770-726-8988
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Fax | 470-689-3325
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Provider Business Mailing Address
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Address Line | 9280 HIGHWAY 5 STE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-1501
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Country | US
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Telephone | 770-726-8988
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Fax | 470-689-3325
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Authorized Official
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Title or Position | CO-PRESIDENT
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Name | DR. CHARLIE ROUSE
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Credential | MD
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Telephone | 678-621-4715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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