Organization
SUSAN WEAVER HAWN, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN W HAWN MD (OWNER)
(706) 367-7621
Entity
Organization
Contact information
Practice address
85 MEMORIAL DR, JEFFERSON, GA 30549-1257
(706) 367-7621
(706) 367-2192
Mailing address
PO BOX 820, JEFFERSON, GA 30549-0820
(706) 367-7621
(706) 367-2192
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
037562
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00665
BCBS GROUP NUMBER
GA
05
—
00838318A
—
GA
01
—
037562
STATE LICENSE NUMBER
GA
01
—
702182
BCBS PROVIDER NUMBER
GA
Enumeration date
01/30/2007
Last updated
10/25/2011
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