Healthcare Provider Details

I. General information

NPI: 1346564234
Provider Name (Legal Business Name): TRAVIS DALTON FARMER MD, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2010
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 TOWNE PARK DR STE 200
RINCON GA
31326-5167
US

IV. Provider business mailing address

210 E DERENNE AVE
SAVANNAH GA
31405-6736
US

V. Phone/Fax

Practice location:
  • Phone: 912-826-2533
  • Fax: 912-826-2572
Mailing address:
  • Phone: 912-644-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number33568
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberBP10066100
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number85073
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: