Individual
CARRIE HALL MERRITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
105 STADIUM OAKS DR, CLEMMONS, NC 27012-8962
(336) 766-0547
(366) 766-0549
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 766-0547
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
TL 1664
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1013204148
BCBS
NC
01
—
NCB656A
MEDICARE
NC
Enumeration date
07/10/2011
Last updated
10/28/2020
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