Provider Demographics
NPI:1245225838
Name:CRAIG, JAMES T JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:CRAIG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OKEENA DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-8819
Mailing Address - Country:US
Mailing Address - Phone:731-668-6540
Mailing Address - Fax:731-668-9609
Practice Address - Street 1:1004 GREYSTONE SQ
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3580
Practice Address - Country:US
Practice Address - Phone:731-668-7375
Practice Address - Fax:731-668-2727
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4665207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175435Medicaid
TN200012576Medicare PIN
TN3175435Medicaid
TND32097Medicare UPIN