Provider Demographics
NPI:1790978120
Name:HAWKESWORTH, GREG JOSEPH (DO)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:JOSEPH
Last Name:HAWKESWORTH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LAKE SUMTER LNDG
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-2699
Mailing Address - Country:US
Mailing Address - Phone:352-674-8905
Mailing Address - Fax:352-674-8901
Practice Address - Street 1:2910 BROWNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32163-2032
Practice Address - Country:US
Practice Address - Phone:352-674-1790
Practice Address - Fax:352-674-8990
Is Sole Proprietor?:No
Enumeration Date:2007-08-20
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS18190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01239514OtherRR MEDICARE
SCGP5464Medicaid
SC010758Medicaid
SC010758Medicaid
SCAA56197043Medicare PIN
SCSC59827842Medicare PIN