Provider Demographics
NPI:1043363716
Name:HAWK, THOMAS H JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:H
Last Name:HAWK
Suffix:JR
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 1:740 PRINCE AVE
Mailing Address - Street 2:BUILDING 8A
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5908
Mailing Address - Country:US
Mailing Address - Phone:706-353-1630
Mailing Address - Fax:706-543-6825
Practice Address - Street 1:740 PRINCE AVE
Practice Address - Street 2:BUILDING 8A
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5908
Practice Address - Country:US
Practice Address - Phone:706-353-1630
Practice Address - Fax:706-543-6825
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA019390208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA341986OtherWELLCARE
GA408023018OtherRAIL ROAD MEDICARE PROV#
GA52004391OtherBLUE CROSS AND BLUE SHIEL
GA10058985OtherAMERIGROUP
GA000185039AMedicaid
GA000185039BMedicaid
GA000185039AMedicaid
GA52004391OtherBLUE CROSS AND BLUE SHIEL