Individual
SHACORA TRAVIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 CARNEY ROAD, QUITMAN, GA 31643
(229) 305-0802
Mailing address
1200 CARNEY ROAD, QUITMAN, GA 31643
(229) 305-0802
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
12/13/2016
Last updated
12/13/2016
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