Provider Demographics
NPI:1164584207
Name:MERRITT, AMANDA S (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:S
Last Name:MERRITT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 PERRY HOUSE RD
Mailing Address - Street 2:PO BOX 1009
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-8837
Mailing Address - Country:US
Mailing Address - Phone:229-423-9237
Mailing Address - Fax:
Practice Address - Street 1:171 PERRY HOUSE RD
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8837
Practice Address - Country:US
Practice Address - Phone:229-423-9237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0130931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice