Provider Demographics
NPI:1285121764
Name:NOVACK, CRAIG PHILLIP (DO)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:PHILLIP
Last Name:NOVACK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 E MCDONOUGH ST UNIT 309
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31401-4074
Mailing Address - Country:US
Mailing Address - Phone:912-604-1304
Mailing Address - Fax:
Practice Address - Street 1:6510 SEAWRIGHT DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-2752
Practice Address - Country:US
Practice Address - Phone:912-235-6000
Practice Address - Fax:912-235-6395
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16835207R00000X
GA88907207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine