Healthcare Provider Details

I. General information

NPI: 1245225838
Provider Name (Legal Business Name): JAMES T CRAIG JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 GREYSTONE SQ
JACKSON TN
38305-3580
US

IV. Provider business mailing address

11 OKEENA DR
JACKSON TN
38305-8819
US

V. Phone/Fax

Practice location:
  • Phone: 731-668-7375
  • Fax: 731-668-2727
Mailing address:
  • Phone: 731-668-6540
  • Fax: 731-668-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4665
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: