Provider Demographics
NPI:1174519011
Name:MERRITT, JAMES O (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:O
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4728 JENN DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-5714
Mailing Address - Country:US
Mailing Address - Phone:843-449-5553
Mailing Address - Fax:843-449-4453
Practice Address - Street 1:911 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572-4116
Practice Address - Country:US
Practice Address - Phone:843-449-5553
Practice Address - Fax:843-449-4453
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SC6403207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC064030Medicaid
SCD18222Medicare UPIN
SC064030Medicaid