Healthcare Provider Details

I. General information

NPI: 1366841041
Provider Name (Legal Business Name): ACACIA OBSTETRICS & GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 WICKER ST
SANFORD NC
27330-4158
US

IV. Provider business mailing address

536 WILMOUTH RD
SANFORD NC
27330-9138
US

V. Phone/Fax

Practice location:
  • Phone: 919-356-7157
  • Fax:
Mailing address:
  • Phone: 919-356-7157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number9400930
License Number StateNC

VIII. Authorized Official

Name: DR. BENJAMIN K MERRITT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 919-356-7157