Healthcare Provider Details

I. General information

NPI: 1376573535
Provider Name (Legal Business Name): PAUL EDWARD CRAFT PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 11/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 W MAIN ST
JAMESTOWN NC
27282-9515
US

IV. Provider business mailing address

1701 WESTCHESTER DRIVE SUITE 850
HIGH POINT NC
27262-7254
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-2015
  • Fax: 336-802-2016
Mailing address:
  • Phone: 336-802-2400
  • Fax: 336-802-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number100070
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: