Provider Demographics
NPI:1740078328
Name:CRAIG, LOGAN (MED)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:CRAIG
Suffix:
Gender:
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 VINE ST APT 53
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2333
Mailing Address - Country:US
Mailing Address - Phone:865-202-1721
Mailing Address - Fax:
Practice Address - Street 1:3309 CUMMINGS HWY STE 110
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37419-2438
Practice Address - Country:US
Practice Address - Phone:423-933-2575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-25
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty