Healthcare Provider Details

I. General information

NPI: 1083753636
Provider Name (Legal Business Name): KEVIN SAM MERIGIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2849 COLLIERVILLE ARLINGTON N
EADS TN
38028-9320
US

IV. Provider business mailing address

PO BOX 205
EADS TN
38028-0205
US

V. Phone/Fax

Practice location:
  • Phone: 901-867-1018
  • Fax: 901-867-1065
Mailing address:
  • Phone: 901-867-1018
  • Fax: 901-867-1065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number21904
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number21904
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code209800000X
TaxonomyLegal Medicine (M.D./D.O.) Physician
License Number21904
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: