Provider Demographics
NPI:1043364409
Name:HAWKINS, DEDRA DIONNE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEDRA
Middle Name:DIONNE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:DEDRA
Other - Middle Name:DIONNE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6141 VALENCIA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-7346
Mailing Address - Country:US
Mailing Address - Phone:678-231-7991
Mailing Address - Fax:
Practice Address - Street 1:730 CENTER ST STE 300
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1529
Practice Address - Country:US
Practice Address - Phone:678-231-7991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021280183500000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist