Healthcare Provider Details

I. General information

NPI: 1003265836
Provider Name (Legal Business Name): HARLEY HENDRIX MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 W. RAILROAD STREET
PEMBROKE GA
31321
US

IV. Provider business mailing address

836 E. 65TH STREET SUITE 22
SAVANNAH GA
31405
US

V. Phone/Fax

Practice location:
  • Phone: 912-653-2897
  • Fax: 912-653-4299
Mailing address:
  • Phone: 912-819-7878
  • Fax: 912-819-3555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberLL39508
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82114
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: