Basic Information
| Provider Information | |||||||||
| NPI: | 1548559693 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAPPS | ||||||||
| FirstName: | ANTONIO | ||||||||
| MiddleName: | CHANTILL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 294 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314231932 | ||||||||
| FaxNumber: | 7314100367 | ||||||||
| Practice Location | |||||||||
| Address1: | 294 SUMMAR DR | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 383013915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7314231932 | ||||||||
| FaxNumber: | 7314100367 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2011 | ||||||||
| LastUpdateDate: | 01/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD60587278 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 34988 | OK | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207Q00000X | 34988 | OK | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 49970 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | MD60587278 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.