Healthcare Provider Details

I. General information

NPI: 1629077375
Provider Name (Legal Business Name): DALIA REBECCA MERCED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 12/15/2023
Certification Date: 12/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 HARMON AVE
FT STEWART GA
31314-5604
US

IV. Provider business mailing address

1061 HARMON AVE STE 1D03
FORT STEWART GA
31314-5674
US

V. Phone/Fax

Practice location:
  • Phone: 912-435-6932
  • Fax: 912-435-6191
Mailing address:
  • Phone: 912-435-6932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number036414
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number36414
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: