Provider Demographics
NPI:1225069503
Name:HENDRICKS, PAUL MEREDITH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MEREDITH
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-308-0280
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:163 WALNUT GROVE CHURCH RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-6104
Practice Address - Country:US
Practice Address - Phone:423-775-6668
Practice Address - Fax:423-775-1054
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000735743AMedicaid
TN1516282Medicaid
TN3080231Medicare ID - Type Unspecified
TNC81741Medicare UPIN