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NPI Code Detail

MEDICARE: CAROLYN GAINES HENDRICKS NP

MEDICARE: CAROLYN GAINES HENDRICKS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LX0001XObstetrics & Gynecology Nurse PractitionerRN057169GA

General Provider Information

NPI Number : 1528142262
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN GAINES HENDRICKS NP
Provider Business Mailing Address
First Line : 3627 SETON HALL WAY
Second Line :
City : DECATUR
State : GA
Zip : 30034-5509
Country : US
Telephone Number : 404-244-2200
Fax Number : 404-638-0309
Provider Business Practice Location Address
First Line : 3110 CLIFTON SPRINGS RD
Second Line : SUITE D
City : DECATUR
State : GA
Zip : 30034-4600
Country : US
Telephone Number : 404-244-2200
Fax Number : 404-638-0309
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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