Individual
MRS. ETTA LISA HAWKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.PH.
Contact information
Practice address
2 PEACHTREE STREET N.E., 37TH FLOOR; MEDICAID DIVISION, ATLANTA, GA 30303-3159
(404) 657-7239
(404) 657-5461
Mailing address
386 SIR WINSTON CT, JONESBORO, GA 30238-4561
(770) 477-1458
(404) 657-5461
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
13969
GA
Other
Enumeration date
03/05/2008
Last updated
03/05/2008
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