Provider Demographics
NPI:1275910192
Name:MERRITT, CLINT (MD)
Entity Type:Individual
Prefix:DR
First Name:CLINT
Middle Name:
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8915
Mailing Address - Country:US
Mailing Address - Phone:706-320-8660
Mailing Address - Fax:706-320-8664
Practice Address - Street 1:1831 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8915
Practice Address - Country:US
Practice Address - Phone:706-320-8660
Practice Address - Fax:706-320-8664
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20061168390200000X
TXBP10052466390200000X
GA88708208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program