Healthcare Provider Details

I. General information

NPI: 1508814047
Provider Name (Legal Business Name): JOE D HENDRIX SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1557 CAROLINA AVE
ORANGEBURG SC
29115
US

IV. Provider business mailing address

1557 CAROLINA AVE
ORANGEBURG SC
29115
US

V. Phone/Fax

Practice location:
  • Phone: 803-533-7464
  • Fax: 803-533-7435
Mailing address:
  • Phone: 803-533-7464
  • Fax: 803-533-7435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number21365
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21365
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: