Healthcare Provider Details

I. General information

NPI: 1710129846
Provider Name (Legal Business Name): REBECCA A HENDRIX FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2009
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2570 BLACKMON DR STE 400
DECATUR GA
30033-6197
US

IV. Provider business mailing address

2570 BLACKMON DR STE 400
DECATUR GA
30033-6197
US

V. Phone/Fax

Practice location:
  • Phone: 470-737-9955
  • Fax:
Mailing address:
  • Phone: 423-643-3772
  • Fax: 423-643-3773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14085
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: