Provider Demographics
NPI:1831621721
Name:HAWKINS, SPENCER (MD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:HAWKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4464
Mailing Address - Country:US
Mailing Address - Phone:850-233-3376
Mailing Address - Fax:
Practice Address - Street 1:2550 WINDY HILL RD SE STE 200
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8654
Practice Address - Country:US
Practice Address - Phone:877-231-3376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-30
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD17592207N00000X, 207ND0101X
MI4301500675207N00000X
GA96959207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology