Provider Demographics
NPI:1386871093
Name:MERRIAM, JAMES A JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:MERRIAM
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2 INNOVATION DR. STE. 400
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-5270
Mailing Address - Country:US
Mailing Address - Phone:864-234-7665
Mailing Address - Fax:864-233-5971
Practice Address - Street 1:2 INNOVATION DR,. STE 400
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-5270
Practice Address - Country:US
Practice Address - Phone:864-235-7665
Practice Address - Fax:864-233-5971
Is Sole Proprietor?:No
Enumeration Date:2009-06-20
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL31767207R00000X
SC31767207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC317678Medicaid
SCSC23268157Medicare PIN