Provider Demographics
NPI:1881060697
Name:HAWKINS, KAITLIN MAYO (OD)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MAYO
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:MAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:911 N 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-2115
Practice Address - Country:US
Practice Address - Phone:706-695-4676
Practice Address - Fax:706-695-7364
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002974152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist