Provider Demographics
NPI:1376535161
Name:HAWKINS, EDWARD LEE (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEE
Last Name:HAWKINS
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 1:406 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-3832
Mailing Address - Country:US
Mailing Address - Phone:336-342-0525
Mailing Address - Fax:336-342-9425
Practice Address - Street 1:406 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-3832
Practice Address - Country:US
Practice Address - Phone:336-342-0525
Practice Address - Fax:336-342-9425
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27283207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8940611Medicaid
NC203551Medicare ID - Type UnspecifiedPROVIDER NUMBER
NCC81926Medicare UPIN