Healthcare Provider Details

I. General information

NPI: 1417377102
Provider Name (Legal Business Name): THOMAS NELSON HAWKEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2704 HENRY ST
GREENSBORO NC
27405-3633
US

IV. Provider business mailing address

2704 HENRY ST
GREENSBORO NC
27405-3633
US

V. Phone/Fax

Practice location:
  • Phone: 336-663-5700
  • Fax: 336-663-5734
Mailing address:
  • Phone: 336-663-5700
  • Fax: 336-663-5734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2021-02136
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2021-02136
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: