1285747493 NPI number — KAREN JENELL CRAIG CFNP

Table of content: KAREN JENELL CRAIG CFNP (NPI 1285747493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285747493 NPI number — KAREN JENELL CRAIG CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRAIG
Provider First Name:
KAREN
Provider Middle Name:
JENELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ABBOTT
Provider Other First Name:
KAREN
Provider Other Middle Name:
JENELL
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285747493
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 E 2ND AVE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
ROME
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30161-3209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-509-3278
Provider Business Mailing Address Fax Number:
706-509-4600

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 TURNER MCCALL BLVD
Provider Second Line Business Practice Location Address:
THE BREAST CENTER
Provider Business Practice Location Address City Name:
ROME
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30165-0233
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-509-6852
Provider Business Practice Location Address Fax Number:
706-509-6858
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN107717 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161722931A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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