Healthcare Provider Details

I. General information

NPI: 1316861545
Provider Name (Legal Business Name): JASMINE JYNAE HAWKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

743 SPRING ST NE
GAINESVILLE GA
30501-3899
US

IV. Provider business mailing address

4836 ORCHARD GROVE WAY
GAINESVILLE GA
30504-6101
US

V. Phone/Fax

Practice location:
  • Phone: 951-375-9579
  • Fax:
Mailing address:
  • Phone: 951-375-9579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: