Individual
DR. JACK LEE CRAIN
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1524 E MOREHEAD ST, CHARLOTTE, NC 28207-1606
(704) 343-4452
(704) 343-3428
Mailing address
1524 E MOREHEAD ST, CHARLOTTE, NC 28207-1606
(704) 343-4452
(704) 343-3428
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200001202683
PHYS PRIVILEGE LICENSE
NC
01
—
28480
MEDICAL BOARD LICENSE
NC
Enumeration date
01/25/2006
Last updated
03/07/2023
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