Provider Demographics
NPI:1598715591
Name:HAWKINS, PRESTON P (MD)
Entity Type:Individual
Prefix:DR
First Name:PRESTON
Middle Name:P
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 740
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-0019
Mailing Address - Country:US
Mailing Address - Phone:770-228-8550
Mailing Address - Fax:678-815-0908
Practice Address - Street 1:601 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4213
Practice Address - Country:US
Practice Address - Phone:770-228-8550
Practice Address - Fax:678-815-0908
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA023169207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000246001AMedicaid
GAGRP1142Medicare ID - Type Unspecified
GA255947667AMedicare PIN
D40099Medicare UPIN