Provider Demographics
NPI:1154329951
Name:HENDRIX, STEPHEN GREGORY (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:GREGORY
Last Name:HENDRIX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1326 EISENHOWER DR
Mailing Address - Street 2:BLDG. 2
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-527-5270
Mailing Address - Fax:912-527-5279
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:BLDG. 2
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-527-5270
Practice Address - Fax:912-527-5279
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023459207KA0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA408552OtherBCBS
SCG23459Medicaid
GA000251512HMedicaid
D40115Medicare UPIN
GA29BDCGFMedicare ID - Type Unspecified