Provider Demographics
NPI:1790439891
Name:FOX, TRAVIS MCKINNEY (BA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MCKINNEY
Last Name:FOX
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:10731 CHAPMAN HWY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-4765
Practice Address - Country:US
Practice Address - Phone:865-573-0698
Practice Address - Fax:865-573-3174
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator