Healthcare Provider Details

I. General information

NPI: 1477544997
Provider Name (Legal Business Name): MARTHA NAN HAWKES PHP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7655 POPLAR AVE SUITE 365
GERMANTOWN TN
38138-3957
US

IV. Provider business mailing address

7655 POPLAR AVE SUITE 365
GERMANTOWN TN
38138-3957
US

V. Phone/Fax

Practice location:
  • Phone: 901-751-3571
  • Fax: 901-751-3572
Mailing address:
  • Phone: 901-751-3571
  • Fax: 901-751-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberP0000001132
License Number StateTN

VIII. Authorized Official

Name: DR. MARTHA NAN HAWKES
Title or Position: NEUROPSYCHOLOGIST
Credential: PHD
Phone: 901-751-3571