MEDICARE: ASHLEY WHITNEY HENDRICKS AGACNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	GAA-NP001129	GA
2	363L00000X	Nurse Practitioner	13711-33	WI
3	363LA2100X	Acute Care Nurse Practitioner	1-148591	AL
4	363LA2100X	Acute Care Nurse Practitioner	1099152	TX

General Provider Information

NPI Number	:	1073025730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY WHITNEY HENDRICKS AGACNP

Provider Business Mailing Address
First Line	:	PO BOX 742616
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-2616
Country	:	US
Telephone Number	:	770-219-8420
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 S ENOTA DR NE STE 100
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30501-3466
Country	:	US
Telephone Number	:	770-219-0950
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2017
Last Update Date	:	05/20/2026

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