Provider Demographics
NPI:1235231606
Name:HANKINS, RANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:HANKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 CALDWELL DR
Mailing Address - Street 2:
Mailing Address - City:HAZLEHURST
Mailing Address - State:MS
Mailing Address - Zip Code:39083-2711
Mailing Address - Country:US
Mailing Address - Phone:601-894-4661
Mailing Address - Fax:601-894-2514
Practice Address - Street 1:213 CALDWELL DR
Practice Address - Street 2:
Practice Address - City:HAZLEHURST
Practice Address - State:MS
Practice Address - Zip Code:39083-2711
Practice Address - Country:US
Practice Address - Phone:601-894-4661
Practice Address - Fax:601-894-2514
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS9969207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS426-04-6812AOtherBLUE CROSS
MS0012939Medicaid
MS080000201Medicare ID - Type Unspecified
MS0012939Medicaid