Provider Demographics
NPI:1528580750
Name:HAWKINS, KLIFFORD
Entity Type:Individual
Prefix:DR
First Name:KLIFFORD
Middle Name:
Last Name: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 1:863 CANAL ST APT 126
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37402-2311
Mailing Address - Country:US
Mailing Address - Phone:808-938-8197
Mailing Address - Fax:
Practice Address - Street 1:1100 E 3RD ST STE G103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403
Practice Address - Country:US
Practice Address - Phone:423-778-2930
Practice Address - Fax:423-778-9875
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI4419225100000X
TN11233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist