Healthcare Provider Details

I. General information

NPI: 1265055735
Provider Name (Legal Business Name): DAVID JAMES MERRILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 CLAXTON AVE N
ELBA AL
36323-1983
US

IV. Provider business mailing address

482 CLAXTON AVE N
ELBA AL
36323-1983
US

V. Phone/Fax

Practice location:
  • Phone: 334-477-4686
  • Fax:
Mailing address:
  • Phone: 334-477-4686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: