Provider Demographics
NPI:1245501592
Name:HAWKINS, CHRYSTAL (NP-BC)
Entity type:Individual
Prefix:MRS
First Name:CHRYSTAL
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:NP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3896 PRINCETON LAKES WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5510
Mailing Address - Country:US
Mailing Address - Phone:404-489-4444
Mailing Address - Fax:
Practice Address - Street 1:3896 PRINCETON LAKES WAY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-5510
Practice Address - Country:US
Practice Address - Phone:404-489-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN172144363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1245501592Medicaid