Provider Demographics
NPI:1831182567
Name:HENDRIX, ERNEST LEE (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LEE
Last Name:HENDRIX
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 1:108 SANDERS ST STE D
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:AL
Mailing Address - Zip Code:35611-2473
Mailing Address - Country:US
Mailing Address - Phone:256-230-1116
Mailing Address - Fax:256-230-1156
Practice Address - Street 1:108 SANDERS ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611-2418
Practice Address - Country:US
Practice Address - Phone:256-230-1116
Practice Address - Fax:256-230-1156
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL16454207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51518076OtherBLUE CROSS PROVIDER NUMBE
AL1749176OtherFIRST HEALTH PROVIDER NUM
AL4034620OtherAETNA PROVIDER NUMBER
AL009933705Medicaid
AL51518076OtherBLUE CROSS PROVIDER NUMBE
AL051554220Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER