Provider Demographics
NPI:1164657649
Name:MERRITT, BRADLEY SAUNDERS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:SAUNDERS
Last Name:MERRITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:761 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLQUITT
Mailing Address - State:GA
Mailing Address - Zip Code:39837-5107
Mailing Address - Country:US
Mailing Address - Phone:229-758-3935
Mailing Address - Fax:229-758-3935
Practice Address - Street 1:761 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLQUITT
Practice Address - State:GA
Practice Address - Zip Code:39837-5107
Practice Address - Country:US
Practice Address - Phone:229-758-3935
Practice Address - Fax:229-758-3935
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16704207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD40642Medicare UPIN