MEDICARE: DR. ANDREW ADAM HENDRICKS 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	207N00000X	Dermatology Physician	24665	NC
2	207NS0135X	Procedural Dermatology Physician	24665	NC

General Provider Information

NPI Number	:	1740246115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW ADAM HENDRICKS MD

Provider Business Mailing Address
First Line	:	4390 FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2677
Country	:	US
Telephone Number	:	910-738-7154
Fax Number	:	910-738-4455

Provider Business Practice Location Address
First Line	:	4390 FAYETTEVILLE RD
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2677
Country	:	US
Telephone Number	:	910-738-7154
Fax Number	:	910-738-4455

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	03/07/2024

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