Provider Demographics
NPI:1700213337
Name:HAWKINS, MARY SUE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:SUE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 VARIATIONS DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1053
Mailing Address - Country:US
Mailing Address - Phone:404-401-9519
Mailing Address - Fax:404-639-3166
Practice Address - Street 1:1600 CLIFTON RD NE # MSA29
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4018
Practice Address - Country:US
Practice Address - Phone:404-639-3385
Practice Address - Fax:404-639-3166
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN110685363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily