Provider Demographics
NPI:1720841331
Name:HAWKINS, GLADNEY (RN)
Entity Type:Individual
Prefix:
First Name:GLADNEY
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:RN
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 471
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-0471
Mailing Address - Country:US
Mailing Address - Phone:470-730-6102
Mailing Address - Fax:470-220-7500
Practice Address - Street 1:1800 PHOENIX BLVD STE 128-12
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5593
Practice Address - Country:US
Practice Address - Phone:470-730-6102
Practice Address - Fax:470-220-7500
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA203514163WW0000X, 163WC0400X, 163WE0003X, 163WH0200X, 163W00000X
133N00000X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health