Provider Demographics
NPI:1295409720
Name:HAWKINS, ALEXIS IRENE
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:IRENE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 BOWHILL CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-9307
Mailing Address - Country:US
Mailing Address - Phone:803-876-5968
Mailing Address - Fax:
Practice Address - Street 1:114 BOWHILL CT
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-9307
Practice Address - Country:US
Practice Address - Phone:803-876-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver