Provider Demographics
NPI:1063905990
Name:CAPPS, JONATHON WESLEY (PA-C)
Entity type:Individual
Prefix:
First Name:JONATHON
Middle Name:WESLEY
Last Name:CAPPS
Suffix:
Gender:M
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1111 GLYNCO PKWY BLDG 1
Mailing Address - Street 2:STE 10
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525
Mailing Address - Country:US
Mailing Address - Phone:912-264-9111
Mailing Address - Fax:
Practice Address - Street 1:1111 GLYNCO PKWY BLDG 1
Practice Address - Street 2:STE 10
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525
Practice Address - Country:US
Practice Address - Phone:912-264-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2018-10-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant