Healthcare Provider Details

I. General information

NPI: 1316939853
Provider Name (Legal Business Name): CRAIG JAMES MALTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 12/15/2009
Certification Date:
Deactivation Date: 03/25/2006
Reactivation Date: 04/03/2006

III. Provider practice location address

652 N. CEDAR AVENUE
COOKEVILLE TN
38501
US

IV. Provider business mailing address

127 N. OAK AVENUE SUITE D
COOKEVILLE TN
38501
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-0116
  • Fax: 931-526-1865
Mailing address:
  • Phone: 931-783-5857
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD026814
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM.D.26814
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: