Provider Demographics
NPI:1366841041
Name:ACACIA OBSTETRICS & GYNECOLOGY
Entity type:Organization
Organization Name:ACACIA OBSTETRICS & GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-356-7157
Mailing Address - Street 1:536 WILMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9138
Mailing Address - Country:US
Mailing Address - Phone:919-356-7157
Mailing Address - Fax:
Practice Address - Street 1:809 WICKER ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4158
Practice Address - Country:US
Practice Address - Phone:919-356-7157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-19
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400930207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty