Provider Demographics
NPI:1497231054
Name:MERRICK, WILLIAM BOOTHE (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BOOTHE
Last Name:MERRICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 SIXTEENTH FAIRWAY
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-7701
Mailing Address - Country:US
Mailing Address - Phone:731-415-0724
Mailing Address - Fax:
Practice Address - Street 1:270 SIXTEENTH FAIRWAY
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-7701
Practice Address - Country:US
Practice Address - Phone:731-415-0724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4267207R00000X
VA0116032199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty