Provider Demographics
NPI:1538283718
Name:HENDRIX, JOHN WALTER III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WALTER
Last Name:HENDRIX
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:408 WEST ALEXANDER AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4031
Mailing Address - Country:US
Mailing Address - Phone:864-227-9393
Mailing Address - Fax:864-227-9377
Practice Address - Street 1:408 WEST ALEXANDER AVENUE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-4031
Practice Address - Country:US
Practice Address - Phone:864-227-9393
Practice Address - Fax:864-227-9377
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29030207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC290303Medicaid