Healthcare Provider Details

I. General information

NPI: 1275796757
Provider Name (Legal Business Name): URSELINE A. HAWKINS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH CAROLINE COLBERT M.S., CCC/SLP

II. Dates (important events)

Enumeration Date: 07/06/2008
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 23RD AVE
MERIDIAN MS
39301-4026
US

IV. Provider business mailing address

PO BOX 2839
MERIDIAN MS
39302-2839
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-3820
  • Fax: 601-703-0125
Mailing address:
  • Phone: 601-703-3480
  • Fax: 601-703-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21770
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: