Healthcare Provider Details

I. General information

NPI: 1548629967
Provider Name (Legal Business Name): LEAH CHRISTINE HAWKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 05/17/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6402 MCCRIMMON PKWY STE 100
MORRISVILLE NC
27560-8139
US

IV. Provider business mailing address

PO BOX 110566
DURHAM NC
27709-5566
US

V. Phone/Fax

Practice location:
  • Phone: 630-740-0574
  • Fax: 919-655-1001
Mailing address:
  • Phone: 919-620-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-06246
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number215358
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: