Provider Demographics
NPI:1114599891
Name:TRAVIS, CURTIS M
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:M
Last Name:TRAVIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3186 PEARCE CT
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-4802
Mailing Address - Country:US
Mailing Address - Phone:678-558-8918
Mailing Address - Fax:
Practice Address - Street 1:3186 PEARCE CT
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-4802
Practice Address - Country:US
Practice Address - Phone:678-558-8918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty