Provider Demographics
NPI:1023157229
Name:HAWKINS, MARK DOUGLAS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DOUGLAS
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1701 WESTCHESTER DR
Mailing Address - Street 2:SUITE 850
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27262-7008
Mailing Address - Country:US
Mailing Address - Phone:336-802-2536
Mailing Address - Fax:336-802-2534
Practice Address - Street 1:3221 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NC
Practice Address - Zip Code:28610-9692
Practice Address - Country:US
Practice Address - Phone:828-459-4445
Practice Address - Fax:828-459-4434
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC96-01628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1013TOtherBLUE CROSS BLUE SHIELD
NC69824OtherMEDCOST
NC891013TMedicaid
NC69824OtherMEDCOST
NC891013TMedicaid