DR. EDWIN PATTON HENDRICKS JR. (NPI# 1871592774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871592774 |
| Entity Type | Individual |
| Full Name | DR. EDWIN PATTON HENDRICKS JR. |
| Credential | D.O. |
| Practice Address |
720 Maine St Demorest GA 30535-5222 |
| Mailing Address |
Po Box 669 Demorest GA 30535-0669 |
| Practice Telephone | 7067783259 |
| Practice Fax Number | 7067768660 |
| Mailing Telephone | 7067783259 |
| Mailing Fax Number | 7067768660 |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2015-04-18 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 022153 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000235661B | 05 | |
| GA | PREFERRED HEALTH PLAN | 135382BF | 01 |
| GA | TAX ID | 581482841 | 01 |
| GA | 336067 | 05 | |
| GA | BCBS OF GEORGIA | 042720 | 01 |
| Street Address |
720 MAINE ST |
| City | DEMOREST |
| State | GA |
| Zip Code | 30535-5222 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396353355 | Kristen Diana Maxwell X | Nurse Practitioner | 396 Historic Highway 441 North, Demorest, GA 30535 | 2020-07-16 |
| 1659925972 | Jared Davis | Physical Therapist | 541 Historic Hiwy 441, Demorest, GA 30535 | 2019-07-25 |
| 1669939070 | Habersham Medical Center Foundation, Inc. | Pharmacy | 541 Old Historic Hwy 441 N Ste 1, Demorest, GA 30535 | 2019-02-22 |
| 1114417128 | The Hospital Authority of Habersham County | Family Medicine | 638 Hwy 441 N Suite B-2, Demorest, GA 30535 | 2018-05-15 |
| 1578077434 | Linh My Dao | Registered Nurse | 541 Historic Hwy. 441-n, Demorest, GA 30535 | 2017-11-29 |
| 1447797063 | Cmvo, LLC | Pharmacy | 4654 Highway 115, Unit 1, Demorest, GA 30535 | 2017-01-20 |
| 1851741128 | Katherine Glenn | Physical Therapy Assistant | 541 Us-441 Bus, Demorest, GA 30535 | 2016-06-17 |
| 1558735886 | Waterfall Emergency Physicians, LLC | Physician Assistant | 541 Historic Hwy 441n, Demorest, GA 30535 | 2015-11-24 |
| 1407278237 | Deborah Gale | Pharmacist | 116 Savannah Ter, Demorest, GA 30535 | 2014-01-14 |
| 1538580576 | Garrett Family Medicine, LLC | Family Medicine | 590 Historic Hwy 441 Lower Level, Demorest, GA 30535 | 2013-12-18 |
| Find all providers in zip 30535 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114417128 | The Hospital Authority of Habersham County | Family Medicine | 638 Hwy 441 N Suite B-2, Demorest, GA 30535 | 2018-05-15 |
| 1538580576 | Garrett Family Medicine, LLC | Family Medicine | 590 Historic Hwy 441 Lower Level, Demorest, GA 30535 | 2013-12-18 |
| 1346580982 | Myfamilydoc LLC | Family Medicine | 1071 441 Historic Hwy N, Suite D, Demorest, GA 30535-4144 | 2013-02-19 |
| 1598920357 | Ravin Batuk Talati | Family Medicine | 1070 Historic Hwy Old 441, Ste. D, Demorest, GA 30535 | 2008-07-22 |
| 1285847343 | The Hospital Authority of Habersham County | Family Medicine | 801 Austin Drive, Demorest, GA 30535 | 2007-05-07 |
| 1992870190 | Edwin P Hendricks, Jr. Do | Family Medicine | 4020 Demorest Mount Airy Hwy, Demorest, GA 30535-5003 | 2006-11-22 |
| 1992723928 | Owen Curtis Byers | Family Medicine | 1040a Historic Hwy 441 N, Demorest, GA 30535 | 2006-07-17 |
| 1437174570 | Joshua L Garrett | Family Medicine | 225 Adams Dr Ste A, Demorest, GA 30535-4578 | 2006-07-12 |
| 1326022328 | Habersham Family Medicine | Family Medicine | 865 Austin Dr, Demorest, GA 30535-4513 | 2005-12-02 |
| 1346222742 | James G Hamilton Jr. | Family Medicine | 676 Historic Hwy 441 N, Demorest, GA 30535 | 2005-11-19 |
| Find all providers in DEMOREST | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.