Provider Demographics
NPI:1679130892
Name:CRAIG, TARA ANNE
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:ANNE
Last Name:CRAIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:75 EMERSON BAY RD STE 102
Practice Address - Street 2:
Practice Address - City:CAROLINA SHORES
Practice Address - State:NC
Practice Address - Zip Code:28467-2498
Practice Address - Country:US
Practice Address - Phone:910-579-8363
Practice Address - Fax:910-579-8306
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-01968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine