Provider Demographics
NPI:1972006716
Name:HAWTHORNE, CHELSEA R (DO)
Entity Type:Individual
Prefix:DR
First Name:CHELSEA
Middle Name:R
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:R
Other - Last Name:STILWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:920 MADISON AVE STE 447
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3438
Mailing Address - Country:US
Mailing Address - Phone:901-448-5364
Mailing Address - Fax:
Practice Address - Street 1:848 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2816
Practice Address - Country:US
Practice Address - Phone:901-287-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7309208000000X
TNUTRESIDENT207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics