Healthcare Provider Details

I. General information

NPI: 1932189818
Provider Name (Legal Business Name): MARK H CRAIG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2147 SOUTHRIDGE DR
TUPELO MS
38801-6405
US

IV. Provider business mailing address

607 GARFIELD ST
TUPELO MS
38801-6337
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-6290
  • Fax: 662-377-6295
Mailing address:
  • Phone: 662-377-6290
  • Fax: 662-377-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number12830
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: