Individual
TRAVIS DAVID WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6 PLAYER CT NW, ROME, GA 30165-2566
(706) 291-0301
Mailing address
6 PLAYER CT NW, ROME, GA 30165-2566
(706) 291-0301
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
054047
GA
207P00000X
Emergency Medicine Physician
20444
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
053109813A
—
GA
Enumeration date
06/14/2006
Last updated
12/29/2011
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