Healthcare Provider Details

I. General information

NPI: 1477743086
Provider Name (Legal Business Name): J. STUART MCCRACKEN, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N DUKE ST # 620
DURHAM NC
27704-3048
US

IV. Provider business mailing address

2609 N DUKE ST # 620
DURHAM NC
27704-3048
US

V. Phone/Fax

Practice location:
  • Phone: 919-220-5439
  • Fax: 919-220-8102
Mailing address:
  • Phone: 919-220-5439
  • Fax: 919-220-8102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number22310
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH STUART MCCRACKEN
Title or Position: PRESIDENT, SOLE OWNER
Credential: M.D.
Phone: 919-220-5439