Provider Demographics
NPI:1336466853
Name:HALTOM, CRAIG ANTHONY (BCHIS)
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:ANTHONY
Last Name:HALTOM
Suffix:
Gender:M
Credentials:BCHIS
Other - Prefix:MR
Other - First Name:CRAIG
Other - Middle Name:ANTHONY
Other - Last Name:HALTOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCHIS
Mailing Address - Street 1:2725 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-1828
Mailing Address - Country:US
Mailing Address - Phone:423-764-5411
Mailing Address - Fax:423-764-0151
Practice Address - Street 1:2725 W STATE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-1828
Practice Address - Country:US
Practice Address - Phone:423-764-5411
Practice Address - Fax:423-764-0151
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN457237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist