Provider Demographics
NPI:1245791722
Name:HENDRICKS, WILLIAM M III (APRN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:HENDRICKS
Suffix:III
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 WATERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-4878
Mailing Address - Country:US
Mailing Address - Phone:770-355-2218
Mailing Address - Fax:
Practice Address - Street 1:565 WATERBROOK DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4878
Practice Address - Country:US
Practice Address - Phone:770-355-2218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22756363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty