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General NPI Number Information
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NPI Number | 1275910192
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Entity Type | Individual
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Provider Name | CLINT MERRITT M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/29/2015
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 1831 5TH AVE
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City | COLUMBUS
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State | GA
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Zip | 31904-8915
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Country | US
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Telephone | 706-320-8660
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Fax | 706-320-8664
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Provider Business Mailing Address
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Address Line | 1245 S UTICA AVE STE 202
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City | TULSA
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State | OK
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Zip | 74104-4200
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Country | US
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Telephone | 918-579-3840
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 88708
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10052466
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 39218
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License Number State | OK
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