# MR. THERON E HAWKINS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1699817098
- **Gender:** Man
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | RN101168 | GA | Yes |

## Other

- **Enumeration date:** 02/13/2007
- **Last updated:** 05/19/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 000885475F | — | GA |
| 01 | — | 01240267 | AMERIGROUP | GA |
| 01 | — | 473153 | WELLCARE | GA |