Provider Demographics
NPI:1346564234
Name:FARMER, TRAVIS DALTON (MD, PHARMD)
Entity Type:Individual
Prefix:DR
First Name:TRAVIS
Middle Name:DALTON
Last Name:FARMER
Suffix:
Gender:M
Credentials:MD, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E DERENNE AVE
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-6736
Mailing Address - Country:US
Mailing Address - Phone:912-644-5300
Mailing Address - Fax:
Practice Address - Street 1:810 TOWNE PARK DR STE 200
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5167
Practice Address - Country:US
Practice Address - Phone:912-826-2533
Practice Address - Fax:912-826-2572
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-21
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33568183500000X
TXBP100661002086S0105X
390200000X
GA850732086S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the Hand
No183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program