Provider Demographics
NPI:1265031777
Name:HAWKINS, ERIC REID
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:REID
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 N COLUMBIA ST APT 1117
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-1803
Mailing Address - Country:US
Mailing Address - Phone:770-905-9660
Mailing Address - Fax:
Practice Address - Street 1:451 N COLUMBIA ST APT 1117
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-1803
Practice Address - Country:US
Practice Address - Phone:770-905-9660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20-139719106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician