Provider Demographics
NPI:1821234014
Name:MERRITT, ANNE C (RD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:MERRITT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4163 LOMAC ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2881
Mailing Address - Country:US
Mailing Address - Phone:334-396-5570
Mailing Address - Fax:334-396-5572
Practice Address - Street 1:4163 LOMAC ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2881
Practice Address - Country:US
Practice Address - Phone:334-396-5570
Practice Address - Fax:334-396-5572
Is Sole Proprietor?:No
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL560133V00000X, 133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALQ60241Medicare UPIN
AL051557124Medicare PIN