Provider Demographics
NPI:1154477461
Name:HAWTHORNE, NICOLE ACCETTURA (MS,RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ACCETTURA
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 AMHERST AVE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29605-2025
Mailing Address - Country:US
Mailing Address - Phone:864-277-4193
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:ELBERTON
Practice Address - State:GA
Practice Address - Zip Code:30635-1830
Practice Address - Country:US
Practice Address - Phone:706-213-2591
Practice Address - Fax:706-283-1657
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002302133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered