Provider Demographics
NPI:1699817098
Name:HAWKINS, THERON E (NP)
Entity Type:Individual
Prefix:MR
First Name:THERON
Middle Name:E
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3862
Mailing Address - Country:US
Mailing Address - Phone:770-536-9864
Mailing Address - Fax:770-297-5012
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE 500
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3862
Practice Address - Country:US
Practice Address - Phone:770-536-9864
Practice Address - Fax:770-297-5012
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2009-05-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN101168363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA473153OtherWELLCARE
GA000885475FMedicaid
GA01240267OtherAMERIGROUP
GA01240267OtherAMERIGROUP