Provider Demographics
NPI:1215940937
Name:CRAIG, STERLING RUFFIN (MD)
Entity type:Individual
Prefix:DR
First Name:STERLING
Middle Name:RUFFIN
Last Name:CRAIG
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 1:2817 NORTH HIGHLAND AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-1789
Mailing Address - Country:US
Mailing Address - Phone:731-661-0061
Mailing Address - Fax:731-661-9107
Practice Address - Street 1:2817 NORTH HIGHLAND AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1789
Practice Address - Country:US
Practice Address - Phone:731-661-0061
Practice Address - Fax:731-661-9107
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2014-05-23
Deactivation Date:2007-12-18
Deactivation Code:
Reactivation Date:2014-05-23
Provider Licenses
StateLicense IDTaxonomies
TNTNMD5509207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3175446Medicaid
3175446Medicare ID - Type Unspecified
TN3175446Medicaid