Provider Demographics
NPI:1902206238
Name:MARTIN, TRAVIS JONES JR
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:JONES
Last Name:MARTIN
Suffix:JR
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 1:215 WESTERN BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5730
Mailing Address - Country:US
Mailing Address - Phone:910-577-8775
Mailing Address - Fax:910-577-8775
Practice Address - Street 1:215 WESTERN BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5730
Practice Address - Country:US
Practice Address - Phone:910-577-8775
Practice Address - Fax:910-577-8775
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1415237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist