Provider Demographics
NPI:1104197748
Name:WADKINS, HAZEL JOYCE (CSFA)
Entity Type:Individual
Prefix:MRS
First Name:HAZEL
Middle Name:JOYCE
Last Name:WADKINS
Suffix:
Gender:F
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:DICKSON
Mailing Address - State:TN
Mailing Address - Zip Code:37055-2316
Mailing Address - Country:US
Mailing Address - Phone:615-686-8473
Mailing Address - Fax:
Practice Address - Street 1:401 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2316
Practice Address - Country:US
Practice Address - Phone:615-686-8473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113346246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant