Provider Demographics
NPI:1225093214
Name:HAWN, SUSAN WEAVER (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:WEAVER
Last Name:HAWN
Suffix:
Gender:F
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:PO BOX 820
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:GA
Mailing Address - Zip Code:30549-0820
Mailing Address - Country:US
Mailing Address - Phone:706-367-7621
Mailing Address - Fax:706-367-2192
Practice Address - Street 1:85 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:GA
Practice Address - Zip Code:30549-1257
Practice Address - Country:US
Practice Address - Phone:706-367-7621
Practice Address - Fax:706-367-2192
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037562207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA080190120OtherMEDICARE RAILROAD PROVIDE
GA00838318AMedicaid
GA702182OtherBCBS PROVIDER NUMBER
GA702182OtherBCBS PROVIDER NUMBER
GA00838318AMedicaid