Provider Demographics
NPI:1255765806
Name:HAWKINS, LANA JENAE (LPMT, MT-BC)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:JENAE
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:LPMT, MT-BC
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:JENAE
Other - Last Name:HAWKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPMT, MT-BC
Mailing Address - Street 1:12060 ETRIS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-1463
Mailing Address - Country:US
Mailing Address - Phone:678-701-1203
Mailing Address - Fax:678-461-8530
Practice Address - Street 1:12060 ETRIS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-1463
Practice Address - Country:US
Practice Address - Phone:678-701-1203
Practice Address - Fax:678-461-8530
Is Sole Proprietor?:No
Enumeration Date:2013-08-29
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10850225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist