Provider Demographics
NPI:1710050471
Name:MERRITT, JENNIFER HOLLAND (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HOLLAND
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4237 RIVER HILLS
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566
Mailing Address - Country:US
Mailing Address - Phone:843-280-8779
Mailing Address - Fax:843-280-6669
Practice Address - Street 1:90 CEDAR LIGHT LN
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6978
Practice Address - Country:US
Practice Address - Phone:843-280-8779
Practice Address - Fax:843-280-6669
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23960207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35281Medicare UPIN
SCAA09526831Medicare PIN
SCAA09523761Medicare PIN