Provider Demographics
NPI:1659312494
Name:HENDRICKS, TIFFANY MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:MARIE
Last Name:HENDRICKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2699 SANDLIN RD SW
Mailing Address - Street 2:SUITE B8
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-7344
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 B8
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-7344
Practice Address - Country:US
Practice Address - Phone:256-301-0560
Practice Address - Fax:256-301-0563
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL26690207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine