Provider Demographics
NPI:1477799427
Name:HENDI, SAMIR
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:
Last Name:HENDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 SAINT IVES LN
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-3775
Mailing Address - Country:US
Mailing Address - Phone:770-868-1946
Mailing Address - Fax:
Practice Address - Street 1:20 SAINT IVES LN
Practice Address - Street 2:
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-3775
Practice Address - Country:US
Practice Address - Phone:770-868-1946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA17056207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine