Provider Demographics
NPI:1568419810
Name:HENDRICKS FAMILY PRACTICE, PC
Entity Type:Organization
Organization Name:HENDRICKS FAMILY PRACTICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:R
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-301-0560
Mailing Address - Street 1:2699 SANDLIN RD SW
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-7343
Mailing Address - Country:US
Mailing Address - Phone:256-301-0560
Mailing Address - Fax:256-301-0563
Practice Address - Street 1:2699 SANDLIN RD SW
Practice Address - Street 2:SUITE B-8
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-7343
Practice Address - Country:US
Practice Address - Phone:256-301-0560
Practice Address - Fax:256-301-0563
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-30
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26531207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102364Medicaid