Provider Demographics
NPI:1710940861
Name:MERRITT, GEORGE N (DPM)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:N
Last Name:MERRITT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1866 BUFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-878-6998
Mailing Address - Fax:850-656-9293
Practice Address - Street 1:1866 BUFORD BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-878-6998
Practice Address - Fax:850-656-9293
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1303213E00000X
GA513213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87707ZMedicare ID - Type Unspecified
T88552Medicare UPIN
GA48SCCCVMedicare ID - Type Unspecified