1841253754 NPI number — DR. STEPHEN SMITH HAWKINS MD

Table of content: YULIYA SKIBCHYK STRICKLAND PA-C (NPI 1124637913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841253754 NPI number — DR. STEPHEN SMITH HAWKINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
STEPHEN
Provider Middle Name:
SMITH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1841253754
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 EAST THIRD STREET
Provider Second Line Business Mailing Address:
SUITE 302
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37403-4115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-664-5165
Provider Business Mailing Address Fax Number:
423-664-5164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 EAST THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37403-4115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-664-5165
Provider Business Practice Location Address Fax Number:
423-664-5164
Provider Enumeration Date:
04/11/2006

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: 207RI0200X , with the licence number:  009456 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RI0200X , with the licence number: 028006 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3185106 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1734349 . This is a "LOUISIANA MEDICAID" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 621726531002 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0005478016 . This is a "AETNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1891884292 . This is a "GROUP N P I" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3081724 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5902599 . This is a "NORTH CAROLINA MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 00304213C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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