Provider Demographics
NPI:1407469976
Name:WELLS-HAWKINS, DAVIONE DAVID
Entity Type:Individual
Prefix:
First Name:DAVIONE
Middle Name:DAVID
Last Name:WELLS-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 1:2209 CHAPEL DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBORN
Mailing Address - State:OH
Mailing Address - Zip Code:45324-2789
Mailing Address - Country:US
Mailing Address - Phone:586-216-7267
Mailing Address - Fax:
Practice Address - Street 1:2209 CHAPEL DR
Practice Address - Street 2:
Practice Address - City:FAIRBORN
Practice Address - State:OH
Practice Address - Zip Code:45324-2789
Practice Address - Country:US
Practice Address - Phone:586-216-7267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty