Provider Demographics
NPI:1376658518
Name:MERRITT, GREGORY W (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:W
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 1:473 COLONY DR # 82
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-7173
Mailing Address - Country:US
Mailing Address - Phone:601-310-4425
Mailing Address - Fax:
Practice Address - Street 1:473 COLONY DR # 82
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-7173
Practice Address - Country:US
Practice Address - Phone:601-310-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09640208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1974625Medicaid
MS370009685OtherRAILROAD MEDICARE
AL009936058Medicaid
MS1559011OtherAMERICAN ADMIN GROUP
MS00115630Medicaid
F69585Medicare UPIN
LA1974625Medicaid