Provider Demographics
NPI:1568707339
Name:HAWKINS, KIMBERLY HARRIS (DPH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:HARRIS
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9122 TENNGA LN
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-4563
Mailing Address - Country:US
Mailing Address - Phone:423-987-4722
Mailing Address - Fax:
Practice Address - Street 1:1600 E 23RD ST
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5707
Practice Address - Country:US
Practice Address - Phone:423-629-4155
Practice Address - Fax:423-629-4155
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5881183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist