MEDICARE: HAWTHORNE MEDICAL ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CC3389	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	06965	OTHER	GA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1689636201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAWTHORNE MEDICAL ASSOCIATES PC

Provider Business Mailing Address
First Line	:	120 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2147
Country	:	US
Telephone Number	:	706-353-8700
Fax Number	:	706-353-7228

Provider Business Practice Location Address
First Line	:	120 HAWTHORNE PARK
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-2147
Country	:	US
Telephone Number	:	706-353-8700
Fax Number	:	706-353-7228

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	MS. SHELLEY D DES JARDINES
Credential	:
Telephone Number	:	706-769-3331

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/15/2010

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Directions to “HAWTHORNE MEDICAL ASSOCIATES PC ” Practice Location

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