Basic Information
| Provider Information | |||||||||
| NPI: | 1346564234 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | TRAVIS | ||||||||
| MiddleName: | DALTON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD, PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 210 E DERENNE AVE | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314056736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9126445300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 810 TOWNE PARK DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | RINCON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 313265167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9128262533 | ||||||||
| FaxNumber: | 9128262572 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2010 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 33568 | TN | N | Pharmacy Service Providers | Pharmacist | 2086S0105X | BP10066100 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2086S0105X | 85073 | GA | Y | Allopathic & Osteopathic Physicians | Surgery | Surgery of the Hand |
No ID Information.