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General NPI Number Information
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NPI Number | 1538559240
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Entity Type | Individual
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Provider Name | MICHAEL DEWAYNE CRAIG CSA
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Gender | Male
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Dates
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Enumeration Date | 02/02/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 3063 BATTLEFIELD PKWY,
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742
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Country | US
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Telephone | 423-667-2883
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Fax | 706-861-1907
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Provider Business Mailing Address
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Address Line | 282 ANGEL LANE,
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City | RINGGOLD
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State | GA
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Zip | 30736
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Country | US
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Telephone | 423-667-2883
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Fax | 706-861-1907
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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