Provider Demographics
NPI:1053443465
Name:HAWKINS, MICHAEL BRIAN (MS, ACI, ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRIAN
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MS, ACI, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6395 SNAPPS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:AFTON
Mailing Address - State:TN
Mailing Address - Zip Code:37616-4821
Mailing Address - Country:US
Mailing Address - Phone:423-329-5618
Mailing Address - Fax:
Practice Address - Street 1:60 SHILOH RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-0595
Practice Address - Country:US
Practice Address - Phone:423-636-7317
Practice Address - Fax:423-636-7404
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAT 00000010082255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer