Provider Demographics
NPI:1346208113
Name:HOWELL, TRAVIS WORTH (MD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:WORTH
Last Name:HOWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-718-7800
Mailing Address - Fax:336-718-7900
Practice Address - Street 1:7130 VILLAGE MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012
Practice Address - Country:US
Practice Address - Phone:336-893-2420
Practice Address - Fax:336-893-2431
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00236207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5904229Medicaid
NC5904229Medicaid