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General NPI Number Information
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NPI Number | 1427920990
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Entity Type | Organization
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Legal Business Name | TRAVIS WOUND CLINIC
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Dates
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Enumeration Date | 09/23/2025
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 99 JOHN TRAVIS RD
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City | POPLARVILLE
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State | MS
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Zip | 39470-7419
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Country | US
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Telephone | 404-368-4140
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Fax | 404-368-4140
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Provider Business Mailing Address
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Address Line | 99 JOHN TRAVIS RD
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City | POPLARVILLE
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State | MS
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Zip | 39470-7419
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Country | US
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Telephone | 404-368-4140
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Fax | 404-368-4140
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Authorized Official
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Title or Position | OWNER
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Name | CONSUELA Y TRAVIS
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Credential | CERTIFIED WOUND CARE
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Telephone | 404-368-4140
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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