Provider Demographics
NPI:1164081311
Name:PERRITT, MARY DEASON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:DEASON
Last Name:PERRITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHRYN
Other - Last Name:DEASON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:611 KENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-6903
Mailing Address - Country:US
Mailing Address - Phone:404-272-9146
Mailing Address - Fax:
Practice Address - Street 1:2700 N OAK ST BLDG B
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-5903
Practice Address - Country:US
Practice Address - Phone:229-249-8687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203206363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner