Provider Demographics
NPI:1477544997
Name:MARTHA NAN HAWKES PHP
Entity Type:Organization
Organization Name:MARTHA NAN HAWKES PHP
Other - Org Name:THE MEDICAL PSYCHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:NAN
Authorized Official - Last Name:HAWKES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:901-751-3571
Mailing Address - Street 1:7655 POPLAR AVE
Mailing Address - Street 2:SUITE 365
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3957
Mailing Address - Country:US
Mailing Address - Phone:901-751-3571
Mailing Address - Fax:901-751-3572
Practice Address - Street 1:7655 POPLAR AVE
Practice Address - Street 2:SUITE 365
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3957
Practice Address - Country:US
Practice Address - Phone:901-751-3571
Practice Address - Fax:901-751-3572
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP0000001132103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
3685330Medicare ID - Type Unspecified