MEDICARE: NANCY C HENDRIX MD

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	208000000X	Pediatrics Physician	020735	GA

General Provider Information

NPI Number	:	1093730095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY C HENDRIX MD

Provider Business Mailing Address
First Line	:	225 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2151
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2151
Country	:	US
Telephone Number	:	706-613-6136
Fax Number	:	706-353-1604

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/08/2007

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