Provider Demographics
NPI:1386917995
Name:MERRITT, LISA JAN (NP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JAN
Last Name:MERRITT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1240 HIGHWAY 54 W
Mailing Address - Street 2:BUILDING 700, SUITE 700
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-4557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 HIGHWAY 54 W
Practice Address - Street 2:BUILDING 700, SUITE 700
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4557
Practice Address - Country:US
Practice Address - Phone:404-452-9931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-13
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine