Craig Paul Moorhouse, ATC
Individual provider Active NPI Specialist · Gray, TN
NPI 1114912904 · NPPES record last updated Nov 24, 2016
Key facts
- NPI
- 1114912904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 394 (TN)
- Practice address
- 1440 Suncrest Dr
Gray, TN 37615-4118 - Phone
- (423) 477-1600
- NPI assigned
- Sep 16, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 394 | TN | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 394 | TN | Yes |
Addresses
Primary practice location
1440 Suncrest Dr
Gray, TN 37615-4118
Mailing address
220 Alfalfa LN
Jonesborough, TN 37659-3175
Phone (423) 202-2355
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 394 | Other | TN | ATHLETIC TRAINING LICENSE |
Other providers in Gray, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 24, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.