Healthcare Provider Details

I. General information

NPI: 1649411505
Provider Name (Legal Business Name): WILLIAM HAWKINS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2009
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4414 LAKE BOONE TRL STE 405
RALEIGH NC
27607-7520
US

IV. Provider business mailing address

30 LAFOY DR
CLAYTON NC
27527-6620
US

V. Phone/Fax

Practice location:
  • Phone: 919-876-8225
  • Fax: 919-876-3371
Mailing address:
  • Phone: 919-995-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0010-01777
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: