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General NPI Number Information
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NPI Number | 1235831512
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Entity Type | Organization
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Legal Business Name | MERIT HEALTH
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 4910 BROWN LEAF DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-8918
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Country | US
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Telephone | 404-693-5565
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Fax | 920-212-2048
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Provider Business Mailing Address
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Address Line | 3721 NEW MACLAND RD STE 200-193
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-2000
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Country | US
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Telephone | 404-693-5565
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Fax | 920-212-2048
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Authorized Official
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Title or Position | CEO
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Name | IGWEBUIKE MOSES UDEZE
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Credential | APRN
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Telephone | 404-693-5565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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