1083940613 NPI number — MRS. POLLY SUZETTE HAWKINS-GUEST LISW-CP

Table of content: MRS. POLLY SUZETTE HAWKINS-GUEST LISW-CP (NPI 1083940613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083940613 NPI number — MRS. POLLY SUZETTE HAWKINS-GUEST LISW-CP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS-GUEST
Provider First Name:
POLLY
Provider Middle Name:
SUZETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LISW-CP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083940613
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
616 BONHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29621-5502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-225-0792
Provider Business Mailing Address Fax Number:
864-226-3968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
616 BONHAM CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621-5502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-844-8019
Provider Business Practice Location Address Fax Number:
864-328-3210
Provider Enumeration Date:
11/02/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  7122 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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