Individual
MR. THERON E HAWKINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5012
Mailing address
1240 JESSE JEWELL PKWY SE, SUITE 500, GAINESVILLE, GA 30501-3862
(770) 536-9864
(770) 297-5012
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN101168
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000885475F
—
GA
01
—
01240267
AMERIGROUP
GA
01
—
473153
WELLCARE
GA
Enumeration date
02/13/2007
Last updated
05/19/2009
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