Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 82114 | GA |
N | 207Q00000X | Family Doctor | LL39508 | SC |
NPI | 1003265836 |
---|---|
Provider Name | Harley Hendrix |
First Address | Savannah, GA 31405 |
Second Address | Pembroke, GA 31321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2016 |
Last Update Date | 12/08/2019 |