Basic Information
| Provider Information | |||||||||
| NPI: | 1902168099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERRITT | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | M. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 W MICHIGAN AVE | ||||||||
| Address2: | PO BOX 1123 | ||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005165315 | ||||||||
| FaxNumber: | 5177877365 | ||||||||
| Practice Location | |||||||||
| Address1: | 6605 ABERCORN ST STE 108 | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314055896 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123557214 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2012 | ||||||||
| LastUpdateDate: | 06/13/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | RN191722 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.