Provider Demographics
NPI:1689019952
Name:HENDRICKS, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
Last Name:HENDRICKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 OLDE WORTHINGTON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-9127
Mailing Address - Country:US
Mailing Address - Phone:614-333-8674
Mailing Address - Fax:877-222-8190
Practice Address - Street 1:470 OLDE WORTHINGTON RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9127
Practice Address - Country:US
Practice Address - Phone:614-333-8674
Practice Address - Fax:877-222-8190
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1367722084P0800X
LAMD.2079532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry