Healthcare Provider Details

I. General information

NPI: 1558328179
Provider Name (Legal Business Name): PAUL WILSON CRAIG II M.D., CIME, AAMRO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 HIGHWAY 645 SUITE 110
INEZ KY
41224
US

IV. Provider business mailing address

1709 KY ROUTE 321 STE 3
PRESTONSBURG KY
41653-9097
US

V. Phone/Fax

Practice location:
  • Phone: 606-298-3412
  • Fax: 606-298-3416
Mailing address:
  • Phone: 606-886-8546
  • Fax: 606-886-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number29912
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number18116
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number18116
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number18116
License Number StateWV
# 5
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number18116
License Number StateWV
# 6
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number29912
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: