=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801094164
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MERRITT H. KING III MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2007
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3980 HIGHWAY 9 E SUITE 110
-----------------------------------------------------
City | LITTLE RIVER
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29566-8163
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-399-3100
-----------------------------------------------------
Fax | 843-399-1099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 3239
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29502-3239
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-777-7042
-----------------------------------------------------
Fax | 843-777-7102
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084A0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
-----------------------------------------------------
License Number | 2009-00460
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 36446
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------