Provider Demographics
NPI:1376676387
Name:HAWKINS, JAMES GRADY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GRADY
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S GILMER AVE
Mailing Address - Street 2:PO BOX 549
Mailing Address - City:LANETT
Mailing Address - State:AL
Mailing Address - Zip Code:36863
Mailing Address - Country:US
Mailing Address - Phone:334-644-2422
Mailing Address - Fax:334-644-4575
Practice Address - Street 1:1601 S GILMER AVE
Practice Address - Street 2:
Practice Address - City:LANETT
Practice Address - State:AL
Practice Address - Zip Code:36863
Practice Address - Country:US
Practice Address - Phone:334-644-2422
Practice Address - Fax:334-644-4575
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist