Provider Demographics
NPI:1235234592
Name:HAWTHORNE, DAYLE C (MD)
Entity Type:Individual
Prefix:
First Name:DAYLE
Middle Name:C
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAYLE
Other - Middle Name:C
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1384 BATTLEFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-4010
Mailing Address - Country:US
Mailing Address - Phone:706-861-2700
Mailing Address - Fax:706-861-2745
Practice Address - Street 1:1384 BATTLEFIELD PKWY
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4010
Practice Address - Country:US
Practice Address - Phone:706-861-2700
Practice Address - Fax:706-861-2745
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22237207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD45611Medicare UPIN