Provider Demographics
NPI:1841849791
Name:HAWKINS, AYANNA
Entity type:Individual
Prefix:
First Name:AYANNA
Middle Name:
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 1:1294 WHITE OAK RD
Mailing Address - Street 2:
Mailing Address - City:TUNICA
Mailing Address - State:MS
Mailing Address - Zip Code:38676-9743
Mailing Address - Country:US
Mailing Address - Phone:662-613-9566
Mailing Address - Fax:
Practice Address - Street 1:1294 WHITE OAK RD
Practice Address - Street 2:
Practice Address - City:TUNICA
Practice Address - State:MS
Practice Address - Zip Code:38676-9743
Practice Address - Country:US
Practice Address - Phone:662-613-9566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No302R00000XManaged Care OrganizationsHealth Maintenance Organization