MEDICARE: GRANT MICHAEL CAPPS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	01087925A	IN
2	171000000X	Military Health Care Provider	01087925A	IN

General Provider Information

NPI Number	:	1922685114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRANT MICHAEL CAPPS MD

Provider Business Mailing Address
First Line	:	1230 BAXTER ST
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-3712
Country	:	US
Telephone Number	:	706-389-3860
Fax Number	:

Provider Business Practice Location Address
First Line	:	7050 AIR DEPOT BLVD
Second Line	:
City	:	TINKER AFB
State	:	OK
Zip	:	73145-8716
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2021
Last Update Date	:	03/24/2026

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