Provider Demographics
NPI:1356980957
Name:HAWK, RICHARD MATTHEW
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:MATTHEW
Last Name:HAWK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 BARNWOOD XING
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2186
Mailing Address - Country:US
Mailing Address - Phone:678-891-8887
Mailing Address - Fax:
Practice Address - Street 1:4233 PLEASANT HILL RD STE 110
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1609
Practice Address - Country:US
Practice Address - Phone:770-559-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)