Provider Demographics
NPI:1831858869
Name:HENDRIX, JORDAN MARTIN (LMSW)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:MARTIN
Last Name:HENDRIX
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:RAY
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:627 STEVENS XING
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9566
Mailing Address - Country:US
Mailing Address - Phone:334-723-6368
Mailing Address - Fax:
Practice Address - Street 1:4039 GATEWAY BLVD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-3389
Practice Address - Country:US
Practice Address - Phone:706-498-9570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSW12393104100000X
GA18047011041S0200X
GAMSW008172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool