Provider Demographics
NPI:1326097262
Name:KRAFT, HOWARD ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ANDREW
Last Name:KRAFT
Suffix:
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:
Practice Address - Street 1:513 DODDS AVE STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3909
Practice Address - Country:US
Practice Address - Phone:423-698-3423
Practice Address - Fax:423-698-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00711174400000X, 2084N0400X
TN572072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2040592DOtherMEDICARE PTAN, INDIVIDUAL
VA1326097262Medicaid
NC5901763Medicaid
NC232009OtherMEDICARE PTAN, GROUP
VA1326097262Medicaid
NC232009OtherMEDICARE PTAN, GROUP