Provider Demographics
NPI:1891807186
Name:HAWKINS, ROBERT LEE JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:HAWKINS
Suffix:JR
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 1:3215 SHRINE RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4385
Mailing Address - Country:US
Mailing Address - Phone:912-267-6211
Mailing Address - Fax:912-267-6238
Practice Address - Street 1:3215 SHRINE RD STE 1B
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4385
Practice Address - Country:US
Practice Address - Phone:912-267-6211
Practice Address - Fax:912-267-6238
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042600208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA28BBBBNMedicare ID - Type Unspecified
GAA53649Medicare UPIN