Active NPI
Mallory Ann Capps, PA-C
- Physician Assistant
- Richmond Hill, GA
National Provider Identifier
1720502230
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2074
- Practice address
- 60 Exchange St Ste B7
Richmond Hill, GA 31324-7646 - Phone
- (912) 756-2273
- Fax
- (912) 756-3773
- NPI assigned
- Jul 27, 2017
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2074 | GA | Primary |
| Physician Assistant | 363A00000X | 2074 | WV |
Addresses
Primary practice location
60 Exchange St Ste B7
Richmond Hill, GA 31324-7646
Mailing address
10 Elm Grove Crossing Mall
Wheeling, WV 26003-5300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180918001927 | GA | Practitioner - Physician Assistant | 0244504330 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2074 | GA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1613088000000",
"number": "1720502230",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 ELM GROVE CROSSING MALL",
"city": "WHEELING",
"state": "WV",
"postal_code": "260035300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 EXCHANGE ST STE B7",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313247646",
"telephone_number": "912-756-2273",
"fax_number": "912-756-3773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAPPS",
"first_name": "MALLORY",
"middle_name": "ANN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-07-27",
"last_updated": "2021-02-12",
"certification_date": "2021-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "2074",
"primary": true
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "2074",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.