1477544997 NPI number — MARTHA NAN HAWKES PHP

Table of content: (NPI 1477544997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477544997 NPI number — MARTHA NAN HAWKES PHP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA NAN HAWKES PHP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
THE MEDICAL PSYCHOLOGY GROUP
Provider Other Organization Name Type Code:
3
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:
1477544997
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7655 POPLAR AVE
Provider Second Line Business Mailing Address:
SUITE 365
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-3957
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-751-3571
Provider Business Mailing Address Fax Number:
901-751-3572

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7655 POPLAR AVE
Provider Second Line Business Practice Location Address:
SUITE 365
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-751-3571
Provider Business Practice Location Address Fax Number:
901-751-3572
Provider Enumeration Date:
11/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HAWKES
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
NAN
Authorized Official Title or Position:
NEUROPSYCHOLOGIST
Authorized Official Telephone Number:
901-751-3571

Provider Taxonomy Codes

  • Taxonomy code: 103G00000X , with the licence number:  P0000001132 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com