Provider Demographics
NPI:1689110496
Name:MERRITT, MACI (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MACI
Middle Name:
Last Name:MERRITT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:OCILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31774-1804
Mailing Address - Country:US
Mailing Address - Phone:229-468-5015
Mailing Address - Fax:
Practice Address - Street 1:202 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:OCILLA
Practice Address - State:GA
Practice Address - Zip Code:31774-1804
Practice Address - Country:US
Practice Address - Phone:229-468-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN160620363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily