Provider Demographics
NPI:1427038587
Name:HOOKS, DEREN H (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEREN
Middle Name:H
Last Name:HOOKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:DEREN
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:900 GORDON AVE
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6613
Mailing Address - Country:US
Mailing Address - Phone:229-226-0125
Mailing Address - Fax:229-226-0195
Practice Address - Street 1:900 GORDON AVE
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6613
Practice Address - Country:US
Practice Address - Phone:229-226-0125
Practice Address - Fax:229-226-0195
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104361363AM0700X
GA4542363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97WCGTNMedicare ID - Type Unspecified
GAQ49571Medicare UPIN