Healthcare Provider Details

I. General information

NPI: 1518955707
Provider Name (Legal Business Name): JOSEPH CREAZZO JR. DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 01/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2263 SANDSTONE DR
MORRISTOWN TN
37814-2593
US

IV. Provider business mailing address

2263 SANDSTONE DR
MORRISTOWN TN
37814-2593
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-0444
  • Fax: 423-353-1209
Mailing address:
  • Phone: 423-581-0444
  • Fax: 423-353-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number000429
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: