Healthcare Provider Details

I. General information

NPI: 1306039730
Provider Name (Legal Business Name): PAUL WINGER HENDRIX D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 JOHNSTON WILLIS DR STE 5500
NORTH CHESTERFIELD VA
23235-4730
US

IV. Provider business mailing address

P O BOX 741030
ATLANTA GA
30384-1030
US

V. Phone/Fax

Practice location:
  • Phone: 804-560-5827
  • Fax: 804-560-5845
Mailing address:
  • Phone: 804-560-5837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number102202525
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number102202525
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: