Provider Demographics
NPI:1326428939
Name:DOGAN, TRAVIS
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:DOGAN
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 1:25 WOODS LAKE RD.
Mailing Address - Street 2:SUITE 410
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-2763
Mailing Address - Country:US
Mailing Address - Phone:864-200-2796
Mailing Address - Fax:864-569-0173
Practice Address - Street 1:25 WOODS LAKE RD.
Practice Address - Street 2:SUITE 410
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2763
Practice Address - Country:US
Practice Address - Phone:864-200-2796
Practice Address - Fax:864-569-0173
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC221569251B00000X, 251C00000X, 251S00000X, 253Z00000X
SC251E00000X
343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)