Provider Demographics
NPI:1790064343
Name:HAWKINS, CARRIE L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARRIE
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29116-1245
Mailing Address - Country:US
Mailing Address - Phone:803-395-4497
Mailing Address - Fax:803-395-2237
Practice Address - Street 1:1175 COOK RD STE 215
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:808-395-3837
Practice Address - Fax:803-536-5122
Is Sole Proprietor?:No
Enumeration Date:2011-08-15
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPPLIED FOR363A00000X
SC1667363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4401Medicaid
SC7496Medicare PIN