Provider Demographics
NPI:1508292939
Name:CRAIG, HARRIS VANN (M D)
Entity Type:Individual
Prefix:
First Name:HARRIS
Middle Name:VANN
Last Name:CRAIG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MANSFIELD DR
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-4930
Mailing Address - Country:US
Mailing Address - Phone:601-442-4769
Mailing Address - Fax:
Practice Address - Street 1:113 MANSFIELD DR
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-4930
Practice Address - Country:US
Practice Address - Phone:601-442-4769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4180208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery