1275796757 NPI number — DR. URSELINE A. HAWKINS M.D.

Table of content: DR. URSELINE A. HAWKINS M.D. (NPI 1275796757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275796757 NPI number — DR. URSELINE A. HAWKINS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAWKINS
Provider First Name:
URSELINE
Provider Middle Name:
A.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLBERT
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CAROLINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., CCC/SLP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275796757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2839
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MERIDIAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39302-2839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-703-3480
Provider Business Mailing Address Fax Number:
601-703-0124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1516 23RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39301-4026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-703-3820
Provider Business Practice Location Address Fax Number:
601-703-0125
Provider Enumeration Date:
07/06/2008

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: 207RE0101X , with the licence number:  21770 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04327059 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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