Healthcare Provider Details

I. General information

NPI: 1689588055
Provider Name (Legal Business Name): CHARELLE JANESE HENDRIX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4262 CLAUSELL CT STE B
DECATUR GA
30035-1916
US

IV. Provider business mailing address

8202 SAINT CLAIR DR NE APT 8202
ATLANTA GA
30329-2686
US

V. Phone/Fax

Practice location:
  • Phone: 478-451-0557
  • Fax:
Mailing address:
  • Phone: 912-755-4603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: