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General NPI Number Information
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NPI Number | 1225069503
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Entity Type | Individual
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Provider Name | PAUL MEREDITH HENDRICKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 02/23/2022
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Provider Practice Location Address
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Address Line | 163 WALNUT GROVE CHURCH RD
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City | DAYTON
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State | TN
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Zip | 37321-6104
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Country | US
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Telephone | 423-775-6668
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Fax | 423-775-1054
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Provider Business Mailing Address
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Address Line | 4976 ALPHA LN
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City | HIXSON
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State | TN
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Zip | 37343-5470
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Country | US
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Telephone | 423-308-0280
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Fax | 423-308-0281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25018
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License Number State | TN
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