Healthcare Provider Details

I. General information

NPI: 1164711313
Provider Name (Legal Business Name): TRAVIS LEE BAILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2011
Last Update Date: 02/13/2024
Certification Date: 02/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 N VALDOSTA RD
VALDOSTA GA
31602-6418
US

IV. Provider business mailing address

3527 N VALDOSTA RD
VALDOSTA GA
31602-6418
US

V. Phone/Fax

Practice location:
  • Phone: 229-247-2290
  • Fax:
Mailing address:
  • Phone: 229-247-2290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101019452
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number073494
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number073494
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: