Provider Demographics
NPI:1871822262
Name:HENDRIX, R C
Entity Type:Individual
Prefix:
First Name:R
Middle Name:C
Last Name:HENDRIX
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 1:206 W RAILROAD AVE S
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39059-2772
Mailing Address - Country:US
Mailing Address - Phone:601-487-3797
Mailing Address - Fax:
Practice Address - Street 1:206 W RAILROAD AVE S
Practice Address - Street 2:
Practice Address - City:CRYSTAL SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39059-2772
Practice Address - Country:US
Practice Address - Phone:601-487-3797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-14
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS001682184172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver