Provider Demographics
NPI:1457457475
Name:MERCHANT, AUDREA (MD)
Entity Type:Individual
Prefix:
First Name:AUDREA
Middle Name:
Last Name:MERCHANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 EMORY VALLEY RD # B
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-7762
Mailing Address - Country:US
Mailing Address - Phone:865-483-3434
Mailing Address - Fax:865-483-6697
Practice Address - Street 1:240 W TYRONE RD
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6517
Practice Address - Country:US
Practice Address - Phone:865-482-1076
Practice Address - Fax:865-481-6166
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2003012642084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891370NMedicaid
105227Medicare UPIN
NC891370NMedicaid