Healthcare Provider Details

I. General information

NPI: 1659993129
Provider Name (Legal Business Name): HAWKINS FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 05/07/2020
Certification Date: 05/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491A CRAFT ST
HOLLY SPRINGS MS
38635-3251
US

IV. Provider business mailing address

491A CRAFT ST
HOLLY SPRINGS MS
38635-3251
US

V. Phone/Fax

Practice location:
  • Phone: 662-252-6416
  • Fax: 662-252-3355
Mailing address:
  • Phone: 662-252-6416
  • Fax: 662-252-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CASSANDRA HAWKINS
Title or Position: OWNER
Credential:
Phone: 901-848-1697