Provider Demographics
NPI:1538559240
Name:CRAIG, MICHAEL DEWAYNE (CSA)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DEWAYNE
Last Name:CRAIG
Suffix:
Gender:M
Credentials:CSA
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Mailing Address - Street 1:282 ANGEL LANE,
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736
Mailing Address - Country:US
Mailing Address - Phone:423-667-2883
Mailing Address - Fax:706-861-1907
Practice Address - Street 1:3063 BATTLEFIELD PKWY,
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742
Practice Address - Country:US
Practice Address - Phone:423-667-2883
Practice Address - Fax:706-861-1907
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-11-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant