Organization
CLINICITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WYATT IRVIN HENDRICKS (COO)
(850) 251-5688
Entity
Organization
Contact information
Practice address
1357 TOM STILL RD, TALLAHASSEE, FL 32305-7541
(850) 251-5688
Mailing address
1357 TOM STILL RD, TALLAHASSEE, FL 32305-7541
(850) 251-5688
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME28955
FL
Other
Enumeration date
11/05/2013
Last updated
11/07/2013
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