Provider Demographics
NPI:1992994123
Name:MERRITT, KRISTI RANICE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:RANICE
Last Name:MERRITT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 HARRISON CT NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2764
Mailing Address - Country:US
Mailing Address - Phone:404-668-4485
Mailing Address - Fax:
Practice Address - Street 1:650 NORTH AVE NE STE 103
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-2749
Practice Address - Country:US
Practice Address - Phone:404-875-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-24
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002318152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA837023997FMedicaid
GA837023997FMedicaid