Provider Demographics
NPI:1679607477
Name:MERRITT, LOUISE CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUISE
Middle Name:CLARK
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 ROBERT PRINCE ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37033-0000
Mailing Address - Country:US
Mailing Address - Phone:931-729-2929
Mailing Address - Fax:
Practice Address - Street 1:704 HIGHWAY 100
Practice Address - Street 2:SUITE 101
Practice Address - City:CENTERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37033-1171
Practice Address - Country:US
Practice Address - Phone:931-729-3573
Practice Address - Fax:931-729-9330
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD 00000362432084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
I 45589Medicare UPIN