Healthcare Provider Details

I. General information

NPI: 1356687875
Provider Name (Legal Business Name): MS. PEGGY ADAMS MERRITT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 01/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2873 HWY 93 S
CAIRO GA
39828-7029
US

IV. Provider business mailing address

2873 HWY 93 S
CAIRO GA
39828-7029
US

V. Phone/Fax

Practice location:
  • Phone: 229-225-8611
  • Fax:
Mailing address:
  • Phone: 229-225-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: