Healthcare Provider Details

I. General information

NPI: 1720841331
Provider Name (Legal Business Name): GLADNEY HAWKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PHOENIX BLVD STE 128-12
ATLANTA GA
30349-5593
US

IV. Provider business mailing address

PO BOX 471
UNION CITY GA
30291-0471
US

V. Phone/Fax

Practice location:
  • Phone: 470-730-6102
  • Fax: 470-220-7500
Mailing address:
  • Phone: 470-730-6102
  • Fax: 470-220-7500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number203514
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number203514
License Number StateLA
# 5
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number203514
License Number StateLA
# 6
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number203514
License Number StateLA
# 7
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number203514
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: