Provider Demographics
NPI:1528198827
Name:MERRITT, HARRY GRIMSHAW JR (DDS)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:GRIMSHAW
Last Name:MERRITT
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:171 PERRY HOUSE ROAD
Mailing Address - City:FITZGERALD
Mailing Address - State:GA
Mailing Address - Zip Code:31750-0927
Mailing Address - Country:US
Mailing Address - Phone:229-423-2535
Mailing Address - Fax:229-423-5949
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:229-423-2535
Practice Address - Fax:229-423-5949
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA76101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice