Provider Demographics
NPI:1184622037
Name:HAWKINS, RAYMOND JR (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38068-0067
Mailing Address - Country:US
Mailing Address - Phone:901-465-6353
Mailing Address - Fax:833-902-3599
Practice Address - Street 1:25 WOODBRIDGE RD STE A
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TN
Practice Address - Zip Code:38068-1242
Practice Address - Country:US
Practice Address - Phone:901-465-6353
Practice Address - Fax:833-902-3599
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD8724208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TND70154Medicare UPIN
TN3156799Medicare ID - Type Unspecified
TN000000006048OtherTLC/MEMPHIS MGD CARE
TND70154Medicare UPIN
TN113225OtherBETTER HEALTH PLAN TN