Individual
MR. STANLEY WAYNE CRADDOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
7301 SARDIS RD, CHARLOTTE, NC 28270-6063
(704) 363-7147
(704) 366-5678
Mailing address
3208 RAVEN GLEN CT, CHARLOTTE, NC 28212-1509
(704) 576-7785
(704) 366-5678
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0086
NC
Other
Enumeration date
06/29/2006
Last updated
07/08/2007
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