Healthcare Provider Details

I. General information

NPI: 1326143033
Provider Name (Legal Business Name): MERRITT CARE PSYCHIATRY PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6817 SOUTHPOINT PKWY SUITE 304
JACKSONVILLE FL
32216-6282
US

IV. Provider business mailing address

6817 SOUTHPOINT PKWY SUITE 304
JACKSONVILLE FL
32216-6282
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-3113
  • Fax: 904-296-3144
Mailing address:
  • Phone: 904-296-3113
  • Fax: 904-296-3144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME49825
License Number StateFL

VIII. Authorized Official

Name: T. CAREY MERRITT
Title or Position: OWNER
Credential: M.D.
Phone: 904-269-3113