Organization
HAWTHORNE MEDICAL ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHELLEY D DES JARDINES (PRACTICE ADMINISTRATOR)
(706) 769-3331
Entity
Organization
Contact information
Practice address
120 HAWTHORNE PARK, ATHENS, GA 30606-2147
(706) 353-8700
(706) 353-7228
Mailing address
120 HAWTHORNE PARK, ATHENS, GA 30606-2147
(706) 353-8700
(706) 353-7228
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06965
BLUE CROSS/BLUE SHIELD
GA
01
—
CC3389
RAILROAD MEDICARE
GA
Enumeration date
04/06/2006
Last updated
02/15/2010
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