Provider Demographics
NPI:1780391060
Name:HAWKINS, ALLIE RENA
Entity type:Individual
Prefix:
First Name:ALLIE
Middle Name:RENA
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12526 CHERYL ANNE PL
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1028
Mailing Address - Country:US
Mailing Address - Phone:336-816-5031
Mailing Address - Fax:
Practice Address - Street 1:12526 CHERYL ANNE PL
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1028
Practice Address - Country:US
Practice Address - Phone:336-816-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program