Provider Demographics
NPI:1609874726
Name:MINES, CRAIG M (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:M
Last Name:MINES
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 1:2820 MAIN ST W
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-3156
Mailing Address - Country:US
Mailing Address - Phone:770-978-1422
Mailing Address - Fax:770-978-1423
Practice Address - Street 1:2820 MAIN ST W
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3156
Practice Address - Country:US
Practice Address - Phone:770-978-1422
Practice Address - Fax:770-978-1423
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057724A174400000X
GA058902207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200445180Medicaid
GA773737921AMedicaid
GA773737921AMedicaid
IN200445180Medicaid