Healthcare Provider Details

I. General information

NPI: 1023848470
Provider Name (Legal Business Name): BRIAN SCOTT MERRITT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2024
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 SE MAIN ST
SIMPSONVILLE SC
29681-3218
US

IV. Provider business mailing address

422 SPARROW HAWK CT
GREER SC
29650-3105
US

V. Phone/Fax

Practice location:
  • Phone: 864-454-6100
  • Fax:
Mailing address:
  • Phone: 864-809-5167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29205
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number217083
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: