Healthcare Provider Details

I. General information

NPI: 1649267576
Provider Name (Legal Business Name): RICKARD S. HAWKINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE SUITE 218
MARIETTA GA
30067-8665
US

IV. Provider business mailing address

3155 N POINT PKWY ATTN: CREDENTIALING DEPT, BUILDING F, SUITE 100
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 770-645-9181
  • Fax: 770-645-8455
Mailing address:
  • Phone: 770-645-9181
  • Fax: 770-645-8455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number40920
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: