Individual
TRAVIS ANDREW DOUGLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 PEACHTREE ST NE, ATLANTA, GA 30308
(404) 686-4411
Mailing address
550 PEACHTREE ST NE, ATLANTA, GA 30308-2212
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
08580
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073969895
—
GA
Enumeration date
05/11/2016
Last updated
07/29/2019
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