Provider Demographics
NPI:1134612971
Name:HAWKINS, CHANDLER MCCARLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:CHANDLER
Middle Name:MCCARLEY
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 EVELYN GANDY PKWY
Mailing Address - Street 2:
Mailing Address - City:PETAL
Mailing Address - State:MS
Mailing Address - Zip Code:39465-3948
Mailing Address - Country:US
Mailing Address - Phone:601-475-5600
Mailing Address - Fax:
Practice Address - Street 1:1115 EVELYN GANDY PARKWAY
Practice Address - Street 2:
Practice Address - City:PETAL
Practice Address - State:MS
Practice Address - Zip Code:39465
Practice Address - Country:US
Practice Address - Phone:014-755-6006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3997-181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice