Provider Demographics
NPI:1255402756
Name:GEORGE, CRAIG CAMERON (NP)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:CAMERON
Last Name:GEORGE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3756 EAST CENTENARY ROAD
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-2033
Mailing Address - Country:US
Mailing Address - Phone:317-834-1852
Mailing Address - Fax:317-834-1852
Practice Address - Street 1:3756 EAST CENTENARY ROAD
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-2033
Practice Address - Country:US
Practice Address - Phone:317-834-1852
Practice Address - Fax:317-834-1852
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28106481A163WA0400X, 163WP0808X
IN71001148A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health