Provider Demographics
NPI:1841224243
Name:HAWKINS, WESLEY (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WYNDCHASE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7529
Mailing Address - Country:US
Mailing Address - Phone:731-616-1558
Mailing Address - Fax:
Practice Address - Street 1:2796 N HIGHLAND AVE
Practice Address - Street 2:SUITE D
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-1846
Practice Address - Country:US
Practice Address - Phone:731-736-0970
Practice Address - Fax:731-736-1909
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36105207P00000X
TNMD36105207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00327732OtherRR MEDICARE
TN3877764Medicaid
4105330OtherBCBS
TN3877763Medicaid
TN3877763Medicare PIN
P00327732OtherRR MEDICARE
TN3877764Medicare PIN