Provider Demographics
NPI:1043508229
Name:CREEKMORE, JOHN (SA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:CREEKMORE
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8000 WATERFORD TIDE LOOP
Mailing Address - Street 2:#2931
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28226
Mailing Address - Country:US
Mailing Address - Phone:336-425-5991
Mailing Address - Fax:
Practice Address - Street 1:8000 WATERFORD TIDE LOOP
Practice Address - Street 2:#2931
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:336-425-5991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3155246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant