Maxwell K Merritt IV

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

C3056A Issued in AL

Practice address

2750 Old Alabama Rd
Johns Creek, GA 30022

Phone

(678) 893-5332

NPI assigned

Jul 28, 2019

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564272000000",
    "number": "1952955031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5350 SCENIC VALLEY DR",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300405484",
            "telephone_number": "570-404-6624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 OLD ALABAMA RD",
            "city": "JOHNS CREEK",
            "state": "GA",
            "postal_code": "30022",
            "telephone_number": "678-893-5332"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10795 Rogers Cir",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "GA",
            "postal_code": "300971979",
            "country_code": "US",
            "telephone_number": "770-497-3860",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10625 Parsons Rd",
            "address_purpose": "LOCATION",
            "city": "Johns Creek",
            "state": "GA",
            "postal_code": "300971717",
            "country_code": "US",
            "telephone_number": "470-254-3828",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MERRITT",
        "first_name": "MAXWELL",
        "middle_name": "K",
        "name_suffix": "IV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-28",
        "last_updated": "2019-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AL",
            "license": "C3056A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Johns Creek, GA
• Providers in Johns Creek, GA by specialty
• Mental Health Counselor in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.