Active NPI
Edwin Patton Hendricks Jr., D.O.
- Family Medicine Physician
- Demorest, GA
National Provider Identifier
1871592774
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 022153
- Practice address
- 720 Maine St
Demorest, GA 30535-5222 - Phone
- (706) 778-3259
- Fax
- (706) 776-8660
- NPI assigned
- Jul 21, 2005
- Last updated
- Apr 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 022153 | GA | Primary |
Addresses
Primary practice location
720 Maine St
Demorest, GA 30535-5222
Mailing address
PO Box 669
Demorest, GA 30535-0669
Phone (706) 778-3259
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 042720 | Other | GA | BCBS OF GEORGIA |
| 000235661B | Medicaid | GA | |
| 135382BF | Other | GA | PREFERRED HEALTH PLAN |
| 581482841 | Other | GA | TAX ID |
| 336067 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022153 | GA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429315200000",
"number": "1871592774",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 669",
"city": "DEMOREST",
"state": "GA",
"postal_code": "305350669",
"telephone_number": "706-778-3259",
"fax_number": "706-776-8660"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 MAINE ST",
"city": "DEMOREST",
"state": "GA",
"postal_code": "305355222",
"telephone_number": "706-778-3259",
"fax_number": "706-776-8660"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDRICKS",
"first_name": "EDWIN",
"middle_name": "PATTON",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-07-21",
"last_updated": "2015-04-18",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "GA",
"license": "022153",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF GEORGIA",
"identifier": "042720",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000235661B",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED HEALTH PLAN",
"identifier": "135382BF",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "581482841",
"state": "GA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "336067",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Demorest, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.