Individual
DR. MARK VINING HENDRICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
840 PINE STREET, SUITE 780, MACON, GA 31201
(478) 744-2445
(478) 744-0906
Mailing address
840 PINE STREET, SUITE 780, MACON, GA 31201
(478) 744-2445
(478) 744-0906
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
043061
GA
207RP1001X
Pulmonary Disease Physician
Primary
043061
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000904219A
—
GA
01
—
290013678
MEDICARE RAILROAD
GA
Enumeration date
11/14/2005
Last updated
10/26/2012
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