Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | DS036032 | PA |
N | 213EG0000X | General Practice | DS036032 | PA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 9048 | SC |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN015542 | GA |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DS036032 | PA |
NPI | 1073670550 |
---|---|
Provider Name | Dr. Travis James Austin |
First Address | Ft Gordon, GA 30905 |
Second Address | Ft Gordon, GA 30905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 02/12/2019 |