Provider Demographics
NPI:1386675320
Name:HAKES, DONALD G (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:G
Last Name:HAKES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 E 3RD ST STE 202
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-2174
Mailing Address - Country:US
Mailing Address - Phone:423-265-2233
Mailing Address - Fax:423-756-8265
Practice Address - Street 1:1010 E 3RD ST STE 202
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-2174
Practice Address - Country:US
Practice Address - Phone:423-265-2233
Practice Address - Fax:423-756-8265
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPAC1237363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508218Medicaid
P79895Medicare UPIN
TN36632841Medicare PIN