Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 4240 | SC |
NPI | 1962878983 |
---|---|
Provider Name | Joseph Wesley Hendricks |
First Address | Mount Pleasant, SC 29464-6002 |
Second Address | Mount Pleasant, SC 29464-6002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2015 |
Last Update Date | 17/03/2018 |