Healthcare Provider Details

I. General information

NPI: 1376676387
Provider Name (Legal Business Name): JAMES GRADY HAWKINS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 INTERSTATE DR
OPELIKA AL
36801-5415
US

IV. Provider business mailing address

1601 S GILMER AVE PO BOX 549
LANETT AL
36863
US

V. Phone/Fax

Practice location:
  • Phone: 334-769-4296
  • Fax: 334-644-4575
Mailing address:
  • Phone: 334-644-2422
  • Fax: 334-644-4575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3851
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN124140
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: