Individual
DR. EDWIN PATTON HENDRICKS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
720 MAINE ST, DEMOREST, GA 30535-5222
(706) 778-3259
(706) 776-8660
Mailing address
PO BOX 669, DEMOREST, GA 30535-0669
(706) 778-3259
(706) 776-8660
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
022153
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000235661B
—
GA
01
—
042720
BCBS OF GEORGIA
GA
01
—
135382BF
PREFERRED HEALTH PLAN
GA
05
—
336067
—
GA
01
—
581482841
TAX ID
GA
Enumeration date
07/21/2005
Last updated
04/18/2015
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